Utilization Review Coordinator

Overview

PURPOSE STATEMENT:

Provide administrative support to the Utilization department.

Responsibilities

ESSENTIAL FUNCTIONS:

• Perform pre-certification and negotiate continued stay with third party payers.

• Gather data to support case management activities, including presentation of gathered data and case notes.

• Coordinate discharge planning with clinical team, maintain CRM database with discharge information and follow up.

• Present case information and the needs of third-party payers to (?).

• Assist in admissions review, concurrent reviews and discharge planning.

• Assist physician in peer review by serving as information resource, gather data to support review and schedule peer review.

• Informs management about the status of current patients; documents utilization activities as instructed. Participates in performance improvement activities.

OTHER FUNCTIONS:

• Perform other functions and tasks as assigned.

Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• High school diploma or equivalent required.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

• Current certification as Registered Addiction Specialist, certified Substance Abuse Counselor or similar certification preferred.

ADDITIONAL REGULATORY REQUIREMENTS:

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While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.