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Utilization Management Coordinator in Philadelphia at Kirkbride Center

Date Posted: 1/27/2018

Job Snapshot

Job Description


Utilization Management Coordinator



The Utilization Management Coordinator will manage the inclusive day-to-day clinical pathway, admission certification, and continued stay reviews to determine medical necessity and appropriateness of services to meet reimbursement requirements mandated by third party payers.

The UM reviews charts on a regular basis for continued stay certifications, documentation monitoring, conduct telephone reviews with third party payers representatives, direct appropriate discharge, act as lead for treatment team, clinical care and medical record documentation.

Primary Duties

  • Obtain precertification for new admission in coordination with Needs Assessment and Admissions
  • Communicate outcome of precertification's process. with Needs Assessments , admissions,  physicians, and billing departments   
  • Work closely with Needs Assessment to ensure the initial assessment meets documentation standards   
  • Facilitates Managed Care Organization (MCO) contract compliance   
  • Ensure admissions reviews are completed within one working day following the admission 
  • Conduct continued stay reviews on last covered day ( or more frequently as necessary)   
  • Enters all certification, denial, appeal data into computer at the end  of the day
  • Conducts in-services with nurses, physicians, social workers, addiction staff, and Therapists regarding documentation requirements
  • Communicates with and leads the treatment tam regarding documentation requirements and meeting continued stay requirements
  • Participates in regular random chart audits as directed by Director of Clinical Utilization and Compliance
  • Receives and reviews performance improvement data from each department/unit and directs participants in the PI process.
  • Completes and routes incident and accident report to Operations department   

Job Requirements


Accountant

PHYSICAL AND MENTAL JOB REQUIREMENTS

Must be able to stoop, kneel, crouch, reach, stand for sustained period of time, walk, pull, lift objects from lower to higher position or horizontally from position to position, finger grasp sizes, shapes, textures, and temperatures, express and exchange ideas orally and potentially loudly, accurately or quickly, perceive the nature of sound with no less than 40db. Loss HZ, 1000Hz, 2000 Hz with or without correction, perform repetitive motions of wrists  hands or fingers.

Light work most of the time, exerting up to 10 pounds of force occasionally, up to 20 pounds of force frequently, and occasionally medium work that is exerting  up to 50 pounds of force.

Orients new employees to the unit/ and or department. 

QUALIFICATIONS

  • Bachelor’s Degree in in Social Work or related  field
  • License preferred.
  • Minimum of two years experience in an in-patient    setting (preferred)

MACHINE AND TOOL USAGE

  • Computer
  • Telephone            
  • Photocopier
  • Fax machine

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