Utilization Review Coordinator

The Utilization Review Coordinator shall maintain an effective, efficient Utilization Review Program and oversees all functions related to admissions and case management.
ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited to, the following:

1. Demonstrates the ability to work closely with the Medical Director, Clinical Director, and all clinical staff to ensure that sufficient documentation is present to justify the clinical necessity and appropriateness of admission and continued stay.
2. Demonstrates the ability to compile statistical reports and submit findings monthly to the required Committee.
3. Demonstrates the ability to evaluate and recommend strategies to improve the efficiency with which services are provided and detect and eliminate under or over utilization.
4. Demonstrates the ability to review cases with insurance/managed care companies/out-of-state entities to include pre-certification, admissions reviews, and continued stay reviews.
5. Demonstrates the ability to work with Medical Records regarding documents sent to any insurance/managed care company.
6. Demonstrates the ability to review charts on a daily basis, report any deficiencies to the appropriate staff, and assisting with getting those deficiencies corrected.
7. Participates as an integral member of the treatment team including attendance and knowledge of scheduling of treatment team reviews, special case reviews, and treatment formulation. In addition, works with parents, guardians and family members to encourage active involvement in treatment of the resident and continuation of active insurance benefits.
8. Attends meetings, prepares reports, and follows policy and procedures to include; patient rights, confidentiality, privacy and the code of ethics.  Participates in performance improvement activities to include staff development and completes all required annual training.   
9. Demonstrates the ability to oversee the Discharge Planning process for each resident to ensure that the process is complete and timely.
10. Demonstrates the ability to keep all information updated in the computer system regarding insurance authorizations and assists Corporate in any billing issues.

QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  An individual must be able to perform the duties in a positive work mode and serve as a positive role model and influence for youth and peers.  The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 

1. AGE

At least twenty-one (21) years of age.
 

1. EDUCATION and/or EXPERIENCE
   1. Licensed RN or Bachelors Degree in the mental/behavioral health field required
   2. (1) year experience in the Utilization Review process and/or two (2) years clinical experience in a psychiatric facility preferred.
   3. Experience working in a children's services program or in a residential setting is preferred.
   4. Strong organizational skills, communication skills and ability to perform detailed work.
   5. Ability to use the English language and medical terminology effectively and to understand/carry out complex oral and written instructions within a prescribed routine.    

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