POSITION SUMMARY: Responsible to conduct initial, concurrent and discharge reviews for patients admitted to our inpatient behavioral health facility.
Ensures that documentation is accurate and complete and reflects a true picture of patient's progress in treatment. Educates members of the treatment team on documentation standards. Works closely with treatment team, physicians, patients and families to coordinate treatment and to communicate issues regarding discharge planning, length of stay and payor issues.
Reports all denials to Director of UR immediately, and communicates any issues/problems. Completes appeals for denied days during the initial denial period while the patient is still hospitalized. Continues to monitor documentation in the medical record, in order to facilitate appeal success.
Must be able to learn different levels of care, and differentiate criteria. Helps plan appropriate step-down, with the help of the discharge planner. Also may be required to complete insurance authorizations for PHP and/or IOP. Our mission is to advocate for our patients so they receive the amount of treatment that is necessary for recovery.