Utilization Review Coordinator
Location
Springfield, MO | United States
Job description
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!
The Utilization Review Coordinator responsibilities include the following:
- Within two working days of admission, obtains initial certification based on established Severity of Illness/Intensity of Service criteria.
- Performs initial coding of admitting diagnosis and calculated tentative DRG and length of stay assignment
- Conducts 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.
- Is knowledgeable of criteria for Medicare, Medicaid, managed care and private insurance coverage.
- Communicates daily with admissions personnel regarding admissions and discharges to various units.
- Is 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.
- Acts on performance improvement issues identified during patient conferences and Utilization Review meetings.
- Maintains and respects confidentiality of patient/physician/personnel information
- Assists 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.
- Provides 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 participates in Utilization Review Committee, performance improvement, varying team meetings and other meetings as appropriate.
- Ensures Hospital Review Plan meets criteria set forth by Medicare, Medicaid and third party payors.
- Demonstrates an ability to be flexible, organized and function under stressful situations.
- Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
- Documentation meets current standards and policies.
Qualified candidates for Utilization Review Coordinator should have the following:
- 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
Our Full-Time benefits include the following:
- 401(k) plan and company match
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Paid Time Off
- Employee Assistance Program
- Supplemental Insurance Plans Available
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