1+ months

UTILIZATION REVIEW COORDINATOR - (111793)

Universal Health Services
Chicago, IL 60602
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  • Job Code
    111793

POSITION SUMMARY: The UtilizationReview Coordinatoris responsible for the overall assurance that patient stays are covered by insurance companies and third party payors. The UM in this role is responsible for contacting payors and providing clinical information to ensure stays are covered and that pts meet medical necessity for this level of care. The UM is primarily responsible for live review, online reviews and reviews conducted by fax and is the hospital liaison between insurance companies and hospital staff including the assigned therapist and psychiatrist. The UM also utilizes MIDAS on a daily basis and generates a daily report to the therapy team to ensure that days covered are known to the treatment team. The UM tracks denials and appeals, Peer to Peers and documents the outcomes of appeals and denials in MIDAS. The UM is also responsible for entering the authorization numbers provided in the EMR to facilitate invoice processing.

REPORTING RELATIONSHIP: The Utilization Care Manager reports operationally and administratively to the Director of Admissions and Referrals.

SCHEDULE: Incumbent will be scheduled on an operational need.

Job Requirements

EXPERIENCE/EDUCATION: Bachelors Degree in nursing, psychology or mental/health/human services field is required; Masters preferred. A minimum of three (3) years direct clinical experience in a medical-psychiatric, psychiatric or mental health setting and at least two years experience in utilization management is preferred. Or equivalent training. Skills in consumer assessment, motivating families and other resources, treatment planning, and communicating with external review organizations or comparable entities is preferred.

LICENSURE/CERTIFICATION: R.N. or M.S.W. or other Masters Level mental health professional licensed or certified in the State of Illinois. Primary Source Verification shall be required through Illinois Department of Professional Regulations

KNOWLEDGE, SKILLS AND ABILITY:

  • Knowledge of code procedures
  • Knowledge of case management techniques
  • Knowledge of consumer assessment, family motivating treatment planning techniques
  • Knowledge of external review organizations (i.e. managed care, Medicaid).
  • Knowledge of consumers rights, advanced directives, adult and child abuse laws, and emergency detention
  • Knowledge of complex consumer care planning
  • Knowledge of payor resources and financial planning
  • Knowledge of computers and various software programs
  • Skill in organizing and prioritizing workloads to meet deadlines
  • Skill in telephone etiquette and paging procedures
  • Effective oral and written communication skills
  • Excellent time management skill.
  • Strong customer service skills
  • Ability to adhere to safety policies and procedures
  • Ability to work as a team player
  • Ability to demonstrate tact, resourcefulness, patience and dedication
  • Ability to accept direction and adhere to policies and procedures
  • Ability to tolerate ambiguity, uncertainty and change
  • Ability to use effective judgment and maintain confidentiality of information

PHYSICAL REQUIREMENTS

  • Ability to stand, sit or walk for long periods (up to eight (8) hours)
  • Ability to lift and carry up to 20 pounds move/transfer file boxes, data processing paper, packages, etc..
  • Ability to use both hands in fine manipulation of small office tools (copier, computer, telephone, calculator, and facsimile machine)
  • Ability to hear and speak well enough to communicate in person and on the telephone
  • Ability to handle a variety of repetitive tasks
  • Demonstrates preventative measures relating to Infection Control concepts
  • Ability to push and pull up to ten (10) pounds (file cabinet drawers)
  • Ability to see well enough to read handwritten and typewritten material
  • Ability to frequently reach, turn and twist above and below the waist (to retrieve files from top and lower shelves)
  • Work continuously in an environment where noise level is frequently high

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Posted: 2019-12-08 Expires: 2020-04-02

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UTILIZATION REVIEW COORDINATOR - (111793)

Universal Health Services
Chicago, IL 60602

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