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Utilization Review - FT - (13433)

Universal Health Services


Location:
FLORENCE, SC
Date:
12/14/2017
2017-12-142018-01-12
Job Code:
13433
Universal Health Services
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Job Details

Deltek Talent Management - Utilization Review - FT - (13433)

Job Details


Utilization Review - FT - (13433)

Facility Name
Palmetto Pee Dee Behavioral Health
Location
FLORENCE, SC 29502 US (Primary)
Career Area
Support & Entry Level
Category
Support Staff
Job Description

::

Position Overview

Responsible for monitoring the effective and efficient use of health care resources by review of patient admission and continued stay appropriateness in all programs of the hospital. He/She interacts with outside agencies, third party payer and managed care companies in accordance with contractual agreements, acting as a patient advocate and a representative of the hospital.

 

Job Functions

  • Negotiate full authorization of days through the provision of timely concurrent information that includes patient status, treatment, and anticipated discharge

  • Provide clinical information to managed care organizations that recognizes their review style, criteria, performance standards, and needs.

  • Coordinates the appeal of clinically denied days with managed care organizations and monitor results.

  • Builds collaborative relationships with needed clinical departments.

  • Proactively identifies patients at risk for denied days and works with treatment teams to minimize appeal risk.

  • When managed care organizations identify problems, coordinate internal departments’ needed actions and ensure follow-through

  • Be knowledgeable of performance standards and expectations of all managed care contracts

  • Facilitate communication between representatives of managed care organizations and key members of staff of Hospital as needed.

  • Collaboratively work with Business Office to identify and appeal denied days within designed contractual protocols.

  • Maintain senior management, medical staff, and clinical departments’ awareness of significant utilization issues and trends via production of written reports describing utilization trends.

  • Provide utilization information as requested by supervisor, hospital CEO, or other departments ina timely and accurate fashion.

  • Maintain Utilization Management files

  • Adheres to hospital policy on time and attendance

  • Meets standards of punctuality

  • Advocates on behalf of patients’ rights and their needs

Job Requirements

::

Requirements

  • Bachelor’s degree in social work or related field.

  • Current Licensure in Social Work preferred.

  • Strong knowledge of UR criteria, managed care organizations, and psychiatric assessment/treatment planning.

 

Other Skills/Abilities                                                      

  • Ability to work in a fast-paced environment.

  • Flexible and not easily frustrated in dealing with differences of opinions.

  • Ability to stoop, kneel, crouch, reach, stand, walk, push, pull, lift, grasp, and be able to perceive the attributes of objects such as size, shape, temperature, and/or texture by touching with skin, particularly that of the fingertips.

  • Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly.

  • Hearing to perceive the nature of sound with no less than 40 db loss @Hz. And 2000 Hz with or without correction.

  • Ability to perceive detail information through oral communication and to make fine discrimination in sound.

  • Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks and visually observe patients on the unit and in therapeutic activities.

 

NOTE:  This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization.

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