UR COORDINATOR

Universal Health Services

Universal Health Services One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $15.8 billion in 2024. UHS was again recognized as one of the World's Most Admired Companies by Fortune; listed in Forbes ranking of America's Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 99,000 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

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Position Summary

The UR Coordinator is responsible for managing the treatment activities offered to the patient, including the appropriate clinical screening of admissions, establishment of treatment plans, interface with the treatment team/external case managers/managed care organizations and implementation and supervision of the discharge planning.

Qualifications

Education: Bachelor's degree from an accredited college or university in social work, mental health or a Nursing degree is preferred. Experience: A minimum of two (2) years direct clinical experience in a psychiatric or mental health setting. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities. Licensure: L.V.N., R.N., L.M.S.W. or LPC is preferred. Additional Requirements: Complete knowledge of crisis intervention techniques.

Standards Of Performance

The essential job functions are categorized under the JCAHO standards of performance.

Case Management

Provide for the implementation of the treatment plan and conduct an ongoing review of the plan to ensure effective implementation of all treatment interventions. Maintain ongoing direct contact with the attending practitioner, treatment coordinator, and various members of the team. Work with the treatment team regarding the Continuum of Care Plan and collaborate with the team when changes are needed. Ensure that the patient attends the appropriate level of care or program as indicated on the treatment plan or as needed when there are changes in the patient's status. Interface with the staff of the appropriate level of care to facilitate a smooth transition at the time of transfer. Maintain necessary documentation of all services and the quality of care. Assure proper tracking of all reviews. Communicate and enforce the documentation requirements with all levels of staff to meet accreditation and certification body regulations. Initiate the denial process and maintain current information at all times in the UR file, and initiate appeals through telephone or written communication. Promote an effective use of resources for patients, customers and the facility with sensitivity to the cost of health care. Ensure that patient rights are upheld. Advocate for the lowest level of care consistent with patient needs. Function as a resource for patient/families/significant others.

Discharge Planning

Coordinate with the treatment team discharge plans that were identified by the treatment team. Monitor the discharge planning activities. Organize the use of resources to keep the patient as close to home as possible, provide liaison to aftercare providers and follow up after discharge to ensure efficacy of the discharge plans.

Treatment Planning

Provide support and assistance to the patient and the patient's support system. Review assessment information with admitting practitioners and treatment coordinator and formulate AXIS IV and V diagnosis (in consultation with admitting practitioner). Plan an episode of care to identify services that will be provided if the patient is moved to a greater or less intensive level of care depending on the needs of the case. Communicate with attending practitioner and treatment team, and other providers of service, to assure continuity of care and expedite the flow of services and transition between levels of care. Provide feedback to the attending practitioner and treatment team members concerning continuing certification of days/services. Communicate with external reviewers and referral sources. Conduct all needed external reviews and maintains documentation of all such interaction. Ensure that third-party payors are notified of, or participate in, decisions about appropriate transitions between levels of care.

Utilization Review

Assist potential patients in gaining access to federal and state support systems. Consult with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete. Provide clinical precertification information to patients, managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days. Coordinate with the insurance company doctor in appeals process and denials process.