What are the responsibilities and job description for the Utilization Review Coordinator position at Pontiac General Hospital?
GENERAL SUMMARY:
Analyzes and evaluates admission information and concurrent clinical documentation to support admission and discharge planning.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Assesses clinical documentation based on recognized criteria.
2. Contacts third party payers to communicate clinical information/complete pre-certification and re-certification parameters.
3. Coordinates with clinical treatment team members to obtain information that supports sustaining admission or preparing discharge plans.
4. Applies criteria for admissions to determine medical necessity and appropriateness of level of care and follows through on appeals for denied claims based on medical necessity.
SUPERVISION:
Reports to the Manager of Social Work and Discharge Planning
KNOWLEDGE, SKILLS AND ABILITIES:
- MINIMUM EDUCATION: High School Diploma
- MINIMUM WORK EXPERIENCE: 1 to 2 years of experience in Utilization Review or Case Management
- CONTACT WITH OTHERS: Interpersonal, verbal and written communication skills to effectively interact with physicians, patients and other hospital personnel. Must be physically able to manage patients per CPI-Non-Violent Crisis Intervention approved techniques, using the least restrictive intervention.
- ANALYTICAL DEMANDS: TB Skin test and mask fit (immediate upon hire and annual). Fingerprinting (immediate upon hire). Comprehensive knowledge of health care practices in the acute care and outpatient settings. Understanding of reimbursement systems. Knowledge of computer applications (Microsoft word, Internet and Excel).
WORKING CONDITIONS:
- PHYSICAL EFFORT: Required to walk, sit and stand for long periods of time. Must be physically able to manage patients per CPI-Non-Violent Crisis Intervention approved techniques, using the least restrictive intervention.
- WORK ENVIRONMENT: Work in well-lighted and well-ventilated environments.
- EQUIPMENT USED: Various medical equipment.
Job Type: Full-time
Pay: Up to $58,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Education:
- Bachelor's (Required)
Experience:
- Utilization review: 2 years (Required)
- Psychiatric care: 2 years (Required)
Work Location: In person
Salary : $58,000