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Utilization Review Coordinator - (198788)

Universal Health Services

Job Code:
Universal Health Services
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Job Details

Deltek Talent Management - Utilization Review Coordinator - (198788)

Job Details

Utilization Review Coordinator - (198788)

Facility Name
ATLANTA, GA 30349 US (Primary)
Career Area
Job Description

Position Summary Responsible for reviewing client insurance benefits and ascertaining level of care (LOC) pre-certifications. Essential Duties and Responsibilities Reviews insurance benefits, collects clinical and medical supporting data, contacts health plans for authorization of appropriate level of care based on medical necessity guidelines and benefits, participates in concurrent reviews and prepares and submits appeals. Demonstrates initiative, effectiveness and timeliness in collecting needed data for and then performingpre-certification and admission external reviews. Advises doctor of any third party patients in theconduct of external clinical reviews. Effectively advocates for patients in the conduct of external clinical reviews with third party payers. Demonstrates knowledge and understanding of Talbott Recovery Campus (TRC) and ASAM criteria for levels of care. Demonstrates initiative and effectiveness in coordinating patient-requested appropriate appeals tothird party payers. Advise Primary Therapist of any change that occurs in patient's benefits status within 24hours. Advise patient/primary therapist of anyadverse determination within 24 hours. Follow up with patient and primary therapist regarding patient's understanding of appeals process. Attends treatment team meetings as assigned, reviews weekly URupdate information. Attends and participates in treatment team meetings and FLASH meetings. Coordinates patient's clinical and after-care needs with treatment team. Performs all other duties as assigned or required.

Job Requirements

2years experience in Utilization Review in a mental health setting required. Experience in PHP/IOP Substance Abuse facility preferred. Experienced

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