Perimeter Healthcare Careers
Utilization Review Coordinator
Perimeter Healthcare Careers, Springfield, Missouri, us, 65897
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Perimeter Behavioral of Springfield has an immediate opening for a Full-Time Utilization Review Coordinator.
We are seeking individuals who are committed to improving the lives of those with mental health illness.
Perimeter Behavioral of Springfield is one of the premier behavioral health hospitals providing inpatient psychiatric treatment for children and teenagers. Comprehensive care is designed for the individual, not the diagnosis. Perimeter Behavioral of Springfield is daily committed to improving patients’ lives by using a patient centered collaborative approach to provide high quality care addressing both the mental health and physical wellbeing of our patients.
Join our team today!
Responsibilities
Within two working days of admission, obtain initial certification based on established Severity of Illness/Intensity of Service criteria
Perform initial coding of admitting diagnosis and calculate tentative DRG and length of stay assignment
Conduct concurrent and/or retrospective review of the patient record as required by the payor. The review includes but is not limited to 1) timeliness of delivery of all ordered services; 2) adequate documentation in the Medical Record of services delivered; 3) appropriate utilization of resources; 4) communication to the physicians of average length of stays as determined by the payor
Be knowledgeable of criteria for Medicare, Medicaid, managed care and private insurance coverage
Communicate daily with admissions personnel regarding admissions and discharges to various units
Be knowledgeable of patient’s financial status, diagnosis and discharge needs
Assist Social Services and physicians to facilitate the timely transfer of patients with appropriate follow‑up care
Act on performance improvement issues identified during patient conferences and Utilization Review meetings
Maintain and respect confidentiality of patient/physician/personnel information
Assist Patient Finance Department with audits and surveys conducted by third‑party payors
Serve as liaison to Primaris, Medical Review Services, and agencies having insurance payment contracts
Assist physicians with appeal process for denials
Provide data as requested by the Utilization Review committee or any of its members. Quarterly report readmissions within 30 days, transfers to other acute care facilities, and prolonged lengths of stay
Actively participate in Utilization Review Committee, performance improvement, varying team meetings and other meetings as appropriate
Ensure Hospital Review Plan meets criteria set forth by Medicare, Medicaid and third‑party payors
Demonstrate an ability to be flexible, organized and function under stressful situations
Consult other departments as appropriate to collaborate on patient care and performance improvement activities
Documentation meets current standards and policies
Qualifications
Must be at least 21 years of age
Graduate of an Accredited School of Practical Nursing or Registered Nursing
Bachelor of Science degree in Nursing or at least a minimum of five (5) years’ nursing experience in the hospital setting with broad clinical experience and knowledge
Experience: Working knowledge of criteria for Medicare, Medicaid, managed care and private insurance coverage
Current nursing licensure in the State of Missouri
Possess and maintain current CPR certification
Schedule: Full‑time Monday – Friday, 8‑hour shifts
Benefits
401(k) plan and company match
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Paid Time Off
Employee Assistance Program
Supplemental Insurance Plans Available
Perimeter Behavioral of Springfield has an immediate opening for a Full-Time Utilization Review Coordinator.
We are seeking individuals who are committed to improving the lives of those with mental health illness.
#J-18808-Ljbffr
Get AI-powered advice on this job and more exclusive features.
Perimeter Behavioral of Springfield has an immediate opening for a Full-Time Utilization Review Coordinator.
We are seeking individuals who are committed to improving the lives of those with mental health illness.
Perimeter Behavioral of Springfield is one of the premier behavioral health hospitals providing inpatient psychiatric treatment for children and teenagers. Comprehensive care is designed for the individual, not the diagnosis. Perimeter Behavioral of Springfield is daily committed to improving patients’ lives by using a patient centered collaborative approach to provide high quality care addressing both the mental health and physical wellbeing of our patients.
Join our team today!
Responsibilities
Within two working days of admission, obtain initial certification based on established Severity of Illness/Intensity of Service criteria
Perform initial coding of admitting diagnosis and calculate tentative DRG and length of stay assignment
Conduct concurrent and/or retrospective review of the patient record as required by the payor. The review includes but is not limited to 1) timeliness of delivery of all ordered services; 2) adequate documentation in the Medical Record of services delivered; 3) appropriate utilization of resources; 4) communication to the physicians of average length of stays as determined by the payor
Be knowledgeable of criteria for Medicare, Medicaid, managed care and private insurance coverage
Communicate daily with admissions personnel regarding admissions and discharges to various units
Be knowledgeable of patient’s financial status, diagnosis and discharge needs
Assist Social Services and physicians to facilitate the timely transfer of patients with appropriate follow‑up care
Act on performance improvement issues identified during patient conferences and Utilization Review meetings
Maintain and respect confidentiality of patient/physician/personnel information
Assist Patient Finance Department with audits and surveys conducted by third‑party payors
Serve as liaison to Primaris, Medical Review Services, and agencies having insurance payment contracts
Assist physicians with appeal process for denials
Provide data as requested by the Utilization Review committee or any of its members. Quarterly report readmissions within 30 days, transfers to other acute care facilities, and prolonged lengths of stay
Actively participate in Utilization Review Committee, performance improvement, varying team meetings and other meetings as appropriate
Ensure Hospital Review Plan meets criteria set forth by Medicare, Medicaid and third‑party payors
Demonstrate an ability to be flexible, organized and function under stressful situations
Consult other departments as appropriate to collaborate on patient care and performance improvement activities
Documentation meets current standards and policies
Qualifications
Must be at least 21 years of age
Graduate of an Accredited School of Practical Nursing or Registered Nursing
Bachelor of Science degree in Nursing or at least a minimum of five (5) years’ nursing experience in the hospital setting with broad clinical experience and knowledge
Experience: Working knowledge of criteria for Medicare, Medicaid, managed care and private insurance coverage
Current nursing licensure in the State of Missouri
Possess and maintain current CPR certification
Schedule: Full‑time Monday – Friday, 8‑hour shifts
Benefits
401(k) plan and company match
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Paid Time Off
Employee Assistance Program
Supplemental Insurance Plans Available
Perimeter Behavioral of Springfield has an immediate opening for a Full-Time Utilization Review Coordinator.
We are seeking individuals who are committed to improving the lives of those with mental health illness.
#J-18808-Ljbffr