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UR COORDINATOR- Part Time - (15353)

Universal Health Services


Location:
TUCSON, AZ
Date:
01/18/2018
2018-01-182018-02-16
Job Code:
15353
Universal Health Services
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Job Details

Deltek Talent Management - UR COORDINATOR- Part Time - (15353)

Job Details


UR COORDINATOR- Part Time - (15353)

Facility Name
Palo Verde Behavioral Health
Location
TUCSON, AZ 85712 US (Primary)
Career Area
Professional
Category
Compliance
Job Description

::Palo Verde Behavioral Health (PVBH) is a 84 bed  private psychiatric facility providing inpatient and intensive outpatient psychiatric services through treatment programs tailored to our patients needs for the purpose of creating positive outcomes. PVBH will build on the excellent skills of our current Psychiatrists, licensed registered nurses, clinical social workers and licensed professional counselors to support these programs.

 Mission Statement

The mission of Palo Verde Behavioral Health is to provide the highest quality of psychiatric patient care through treatment programs focused on improving the lives of our patients and ensuring their experience during their stay supports their road to recovery.

Vision Statement

Palo Verde Behavioral Health will be recognized as the premier regional provider of innovative, compassionate behavioral health services, which enhance the health of our community. We will exceed the expectations of those served, maintain the highest standards, and promote a rewarding work environment.

JOB DESCRIPTION:

Provide an ongoing, systematic process for the assessment of the necessity and efficiency of the use of Palo Verde Behavioral Health services, assists in the promotion and maintenance of high quality patient care through the review and evaluation of clinical practices and the review of patient cases for appropriateness of admission, continued stay and discharge planning.

Job Requirements

::

JOB REQUIREMENTS:

To perform this job successfully, an individual must be able to demonstrate competency in the criteria listed in this job description. The specifications listed below are representative of the knowledge, skill, and ability to meet the minimum requirements for this position. Staff must demonstrate knowledge and skill in provision of services to various populations including children, adolescents, adults, older adults and dually diagnosed patients in an inpatient setting.

Education:                          Licensed as a Registered Nurse in the State of Arizona or have a Master’s             Degree in a Behavioral Health field (e.g. Counseling, Psychology or Social Work) preferred.

Experience:                                1 years of full-time related professional experience or graduate-level or specialized education in a specialty area related to the work at Palo Verde Behavioral Health preferred.

Licensure/ Certification:              Part Time position does not require licensure.  Full time positions maintains current licensure adhering to regulations and education hour’s  requirement of UHS, Arizona, and the Federal government if applicable.

SKILLS:

Coordinate and ensure authorization of patient’s treatment with network and non-network providers; this includes all Medicaid, Private Insurance, and Self Pay clients.

Ensures the UR plan meets requirements of regulatory and licensing groups

Performs the overall action of providing and ongoing, systematic process for the assessment of the necessity and efficiency of the use of Palo Verde Behavioral Health services

Assists in the promotion and maintenance of high quality patient care through the review and evaluation of clinical practices

Communication with internal and external entities to facilitate acquisition of resources

Maintains an awareness of funding sources needs and status and initiates appropriate action

Plans, organizes and or reviews the functions of Palo Verde Behavioral Health case management system to minimize denials of payment

Manages, prepares, submits and conducts follow-up on appeal to third party payers on clinical denials.Reviews payer contracts and regulatory requirements on an ongoing basis, updates pertinent policies and procedures and trains staff on special requirements

Conducts post-admission and concurrent reviews and communicates pertinent information to payer and treatment team when needed if applicable.

Document all concurrent reviews and retrospective reviews.

Alert clinicians of any lack of needed UM documentation for priority completion.

Alert Nursing and Clinical Services Director of any abnormalities in the UM process.

Provide ongoing data entry in the Network Utilization Management MIDAS software System.

Provide timely communication, and assistance to the insured of denials and the appeal process.

Gather information and orchestrate needed MD to MD reviews in the UM process.

 

SUPERVISION EXERCISED:   None

 

SUPERVISION RECEIVED:     Chief Financial Officer

 

GENERAL WORKING ENVIRONMENT: Work in general office environment and hospital units/programs. Exposure to psychiatric patients’, who may exhibit violent/aggressive behavior. Potential for exposure to communicable diseases, blood/body fluids and other hazardous waste.

PHYSICAL REQUIREMENTS:

Must be able to talk, hear, and see.Specific vision abilities required include close vision and the ability to adjust focus.

Regularly required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls, and reach with hands and arms.

Frequently lift or move up to 30 to 40 pounds.

Must be able to physically restrain or assist patients

JOB SPECIFICATIONS: To perform this job successfully, an individual must be able to perform each primary duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/ or ability required. Reasonable accommodations may be made to enable individuals with disabilities, who are otherwise qualified, to perform the primary functions.

Communication               

Communicate necessary information related to patient crises or issues to the assigned therapist.
Observe phone protocol and procedures as outlined in the Patient Manual and communicate in a friendly and professional manner.
Protect patient confidentiality and resident rights as outlined in the Patient Manual.

Performance Improvement

Contribute to achievement of performance improvement and actively participate in PI activities.

 

Performance Standards

1.    Productivity & Initiative

Displays enthusiasm and a positive attitude

Identifies program weaknesses or problems and is creative in recommending solutions

Demonstrates sound judgment by taking appropriate actions on questionable findings or concerns: Investigates and follows thru on unusual orders or requests for service or information.

Contributes to achievement of performance improvement and participates in PI activities

Minimizes non-productive time and fills slow periods with activities that will help prepare to meet the future needs of the program (education, organizing, and housekeeping, assisting others).

Demonstrates ability to take the initiative to make decisions/choices without direct supervision

Is reliable and on time when scheduled for work and gives advance notice of scheduling conflicts

2.    Position Knowledge & Accountability

Demonstrates knowledge and understanding of all policies and procedures and ability to reference them from appropriate books and manuals

Demonstrates ability to function independently in managing and coordinating care

Attends as needed in-service training

Attends annual Handle with Care training

Demonstrates knowledge and understanding of Palo Verde Behavioral Health’s UM policies and procedures and shows ability to reference them from appropriate guides, books, manuals, and supervisor

Demonstrates knowledge and understanding of UM admit notification process, concurrent reviews, level of care guidelines, MD to MD reviews, appeals, discharge notification, and medical records reviews

Demonstrates ability to function independently in managing and coordinating full-time UM case load

Proficient in notifying and updating the insured/responsible party of authorizations, denials, and appeal options

Proficient in scheduling, arranging, and communicating MD reviews

3.    Documentation

Accurately transcribes physician orders and progress notes according to policy and procedure

Entries are timely, informative, and follow standard NSG progress note format

Documents timely progress updates in patient’s treatment plan

4.    Teamwork

Participates in orientation of new staff

Works in a positive and cooperative manner with fellow team members

Assists other team members in the performance of their assignments by seeking out opportunities to help rather than waiting to be asked, and by considering the impact of actions on other team members

Recognizes the need for variations in the staffing and volunteers to fill open shifts

Takes direction and initiates actions (cross/additional training) that will allow the assumption of cross functional duties to ensure seamless patient care

5.    Teachability

Accepts constructive criticism and feedback and uses it to improve performance

Is responsive to direction and follows through on assignments

 

 

 

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