PRN Utilization Review Admin

PRN Utilization Review Admin

Good Hope Hospital - Erwin, NC 28339

Description

Our mission is to inspire and empower people to seek and maintain recovery and health. Daymark Recovery Services, Inc. is a mission driven, comprehensive community provider of culturally sensitive mental health and substance abuse services.

Comprehensive Benefits Package

• Medical, Dental and Vision Insurance
• Health Spending Account
• Company-Paid Life Insurance
• Short Term Disability
• 401(k)
• Paid Holidays
• Paid Vacation and Sick Leave
• Employee Assistant Program
• Referral Bonus Opportunities
• Extensive Internal Training Program

Pay Scale: $18.00-23.00/hr. salary based on education and experience

Summary:

The Utilization Review Coordinator initiates pre-certification calls for private insurance and managed Medicare and Medicaid plans and provides concurrent reviews throughout the patient stays.

Essential Duties and Responsibilities:

• Tracks utilization review outcomes
• Assess and reassesses the quality of patient progress notes
• Maintains insurance contact information
• Manages insurance appeal process and work with the client hospital's denial management coordinator
• Communicates treatment team recommendations
• Attends treatment team meetings
• Participates as an active member of the interdisciplinary team
• Addresses issues in a timely manner and informs Program Director of progress
• Provides ongoing education to management and staff for performance improvement
• Continuous education of legislative and insurance changes in regard to continued stay requirements
• Provides resources and suggestions to third party payors regarding aftercare and discharge continued care
• Performs as liaison with appropriated interested parties and physicians through the utilization process
• Responds to requests for general information about the unit's treatment program, and provides information about appropriate topics in response to community requests. Informs Program Director and Nurse Manager of any issues identified by insurance reviewers
• Coordinates treatment with other health and social agencies
• Identifies areas needing improvement and utilizes the facility performance improvement process
• Disseminates pertinent findings/data to referral sources as needed
• Stays informed on all clinical services and program changes in order to appropriately represent payor sources
• Completes all pertinent staff competencies

• All other duties as assigned by supervisor

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Highly motivated and resilient professional
• Strong negotiation skills
• Demonstrated leadership and supervisory experience
• Demonstrated ability to positively lead change and gain results
• Some knowledge of or willing to learn clinical practice models
• Demonstrated ability to understand economic, business and operational factors
• Preceptor and teaching experience helpful
• Strong critical-thinking/problem-solving skills
• Proven conflict management/resolution skills
• High professional ethics and standards
• Strong team player and team building skills; ability to collaborate with all levels and areas
• Strong presentation skills
• Proven relationship-building and management skills
• Ability to effectively and positively influence and persuade

Education and/or Experience: A Bachelor's Degree from an accredited college with a major in chemical dependency, psychology, social work, counseling, nursing or other related field is preferred; and/or Minimum three years' of experience in a similar position and/or industry.