Quail Run Behavioral Health
Utilization Management Coordinator FT
Quail Run Behavioral Health, Phoenix, Arizona, United States, 85003
Utilization Management Coordinator FT
Quail Run Behavioral Health
Responsibilities
Contacts external case managers/managed care organizations for certification and recertification of insurance benefits throughout patient stay and assists the treatment team in understanding insurance company requirements for continued stay and discharge planning.
Has a thorough understanding of patient treatment through communication with the treatment team.
Advocates for patient access to services during treatment team meetings and through individual physician contact.
Reviews treatment plan and advocates for additional services as indicated.
Promotes effective use of resources for patients.
Ensures that patient rights are upheld.
Maintains ongoing contact with the physician, program manager, nurse manager, and various members of the team.
Collaborates with the treatment team regarding continued stay and discharge planning issues.
Advocates that the patient is placed in the appropriate level of care and program.
Interfaces with program staff to facilitate a smooth transition at the time of transfer or discharge.
Maintains documentation related to Utilization Review activities, assures tracking of insurance reviews, and ensures reviews are completed in a timely manner.
Maintains statistical reports and prepares documentation of significant findings.
Communicates insurance requirements to all levels of staff.
Provides timely updates regarding patient status on log sheets prepared for daily meetings concerning admissions, reviews, and discharges; updates the denial log statistics on an ongoing basis (at least weekly) and initiates appeals through telephone or written communication within 7 to 10 days of denial.
Consults with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete.
Provides clinical information to managed care companies, insurance companies and other third‑party reviewers to establish the length of stay or number of certified days.
Coordinates with the insurance company doctor in the appeals process and denial process.
Treatment Planning
Review assessment information.
Communicate with attending physicians and program managers, and other providers of service, to assure continuity of care, efficiency, and effective transitions between levels of care.
Provide feedback to the attending physician and treatment team members concerning continuing certification of days/services.
Communicate with external reviewers and referral sources; conduct external reviews and maintain documentation of interactions.
Ensure that third‑party payers are notified of, or participate in, decisions about transitions between levels of care.
Qualifications A minimum of two (2) years experience in a healthcare setting or managed care company, preferred hospital experience. Bachelor's degree, master's preferred.
EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.
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Responsibilities
Contacts external case managers/managed care organizations for certification and recertification of insurance benefits throughout patient stay and assists the treatment team in understanding insurance company requirements for continued stay and discharge planning.
Has a thorough understanding of patient treatment through communication with the treatment team.
Advocates for patient access to services during treatment team meetings and through individual physician contact.
Reviews treatment plan and advocates for additional services as indicated.
Promotes effective use of resources for patients.
Ensures that patient rights are upheld.
Maintains ongoing contact with the physician, program manager, nurse manager, and various members of the team.
Collaborates with the treatment team regarding continued stay and discharge planning issues.
Advocates that the patient is placed in the appropriate level of care and program.
Interfaces with program staff to facilitate a smooth transition at the time of transfer or discharge.
Maintains documentation related to Utilization Review activities, assures tracking of insurance reviews, and ensures reviews are completed in a timely manner.
Maintains statistical reports and prepares documentation of significant findings.
Communicates insurance requirements to all levels of staff.
Provides timely updates regarding patient status on log sheets prepared for daily meetings concerning admissions, reviews, and discharges; updates the denial log statistics on an ongoing basis (at least weekly) and initiates appeals through telephone or written communication within 7 to 10 days of denial.
Consults with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete.
Provides clinical information to managed care companies, insurance companies and other third‑party reviewers to establish the length of stay or number of certified days.
Coordinates with the insurance company doctor in the appeals process and denial process.
Treatment Planning
Review assessment information.
Communicate with attending physicians and program managers, and other providers of service, to assure continuity of care, efficiency, and effective transitions between levels of care.
Provide feedback to the attending physician and treatment team members concerning continuing certification of days/services.
Communicate with external reviewers and referral sources; conduct external reviews and maintain documentation of interactions.
Ensure that third‑party payers are notified of, or participate in, decisions about transitions between levels of care.
Qualifications A minimum of two (2) years experience in a healthcare setting or managed care company, preferred hospital experience. Bachelor's degree, master's preferred.
EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.
#J-18808-Ljbffr