Utilization Review Coordinator

PORT ST LUCIE HOSPITAL - 2.1

Port Saint Lucie, FL Job Details Full-time 1 day ago Benefits Health insurance Dental insurance 401(k) Flexible spending account Paid time off Vision insurance Life insurance Qualifications CPR Certification Teamwork RN License BLS Certification Attention to detail Organizational skills Health information management

Full Job Description Utilization Review Coordinator Location:

Everwell Port St. Lucie Hospital, Inc Position Summary Everwell Port St. Lucie Hospital is seeking a detail-oriented Utilization Review Coordinator to coordinate insurance reviews, monitor patient authorizations, and support effective communication between the hospital, physicians, and insurance providers. Key Responsibilities Review all patients' admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures. Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria. Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services. Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices. Contacts physicians and primary Nurses for clarification of information as necessary. Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies. Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested. Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated. Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues. Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings. Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups. Performs special projects or other related work as required or requested. Shows ability to communicate in a clear and concise manner. Demonstrates ability to work with others. Adapt to changing situations or work assignments. Demonstrates willingness to rotate to other areas of hospital within the limits of preparation and skill level. Conform to uniform and dress code, personal hygiene and good grooming. Wear and properly display name badge. Positively respond to guidance or counseling and attempts to benefit by it. Adept in identifying potential problems within the department and seeks management guidance. Demonstrates excellent organizational skills and originator of new ideas and methods. Use verbal and non-verbal communication with others, i.e., courtesy, tone of voice, facial expressions, gestures, etc. Demonstrates an understanding of and adherence to the Code of Conduct Conduct reflects Oglethorpe's values and a commitment to the Code of Conduct Qualifications and Education RN, LPN or Master's Level Clinician with experience CPR Certification required Minimum 2 years of healthcare experience preferred Knowledge of utilization review processes and medical terminology Experience working with insurance companies and behavioral health documentation preferred Ability to use data collection techniques, and statistical computations. Strong communication, organizational, and analytical skills Familiarity with DSM criteria and healthcare compliance standards preferred Thorough knowledge of effective and appropriate charting principles Work Environment Primarily indoor, temperature-controlled healthcare environment Collaborative team-focused setting Benefits Medical, Dental and Vision insurance 401K PTO and Sick time This position requires a pre-employment Level 2 Background check: https://info.flclearinghouse.com

Benefits:

401(k) Dental insurance Flexible spending account Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person