UR Coordinator

UR Coordinator Holly Hill Hospital - 2.4 Raleigh, NC Job Details Full-time 1 day ago Benefits Disability insurance Health insurance Dental insurance 401(k) Paid time off Vision insurance 401(k) matching Qualifications Crisis intervention Collaborate with healthcare professionals Treatment plan development Appeals Nursing Insurance prior authorization Utilization review Healthcare resource management Bachelor's degree in social work Accreditation standards (regulatory compliance area) Psychiatry RN License LMSW Patient assessment Insurance claim appeals processing Licensed Clinical Social Worker LPC Patient advocacy Mid-level Bachelor's degree Case management Utilization management Clinical documentation Medical insurance appeals management Discharge planning Working with individuals with mental health conditions Healthcare diagnosis Social Work Care coordination 2 years Interdisciplinary behavioral health coordination Communication skills Full Job Description One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, our annual revenues were $11.4 billion in 2019. In 2020, UHS was again recognized as one of the World's Most Admired Companies by Fortune; in 2019, ranked #293 on the Fortune 500; and in 2017, listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies. Headquartered in King of Prussia, PA, UHS has more than 90,000 employees and through its subsidiaries operates 26 acute care hospitals, 328 behavioral health facilities, 42 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 37 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom

POSITION SUMMARY

The UR Coordinator is responsible for managing the treatment activities offered to the patient, including the appropriate clinical screening of admissions, establishment of treatment plans, interface with the treatment team/external case managers/managed care organizations and implementation and supervision of the discharge planning.

QUALIFICATIONS

Education :

Bachelor's degree from an accredited college or university in social work, mental health or a Nursing degree is preferred.

Experience:

A minimum of two (2) years direct clinical experience in a psychiatric or mental health setting. Experience in patient assessment, family motivation, treatment planning and communication with external review organizations or comparable entities.

Licensure:

L.V.N.,R.N., L.M.S.W. or LPC is preferred.

Additional Requirements:

Complete knowledge of crisis intervention techniques.

STANDARDS OF PERFORMANCE THE ESSENTIAL JOB FUNCTIONS ARE CATEGORIZED UNDER THE JCAHO STANDARDS OF PERFORMANCE

. Case Management 1. Provide for the implementation of the treatment plan and conduct an ongoing review of the plan to ensure effective implementation of all treatment interventions. 2. Maintain ongoing direct contact with the attending practitioner, treatment coordinator, and various members of the team. 3. Work with the treatment team regarding the Continuum of Care Plan and collaborate with the team when changes are needed. 4. Ensure that the patient attends the appropriate level of care or program as indicated on the treatment plan or as needed when there are changes in the patient's status. 5. Interface with the staff of the appropriate level of care to facilitate a smooth transition at the time of transfer. 6. Maintain necessary documentation of all services and the quality of care. 7. Assure proper tracking of all reviews. 8. Communicate and enforce the documentation requirements with all levels of staff to meet accreditation and certification body regulations. 9. Initiate the denial process and maintain current information at all times in the UR file, and initiate appeals through telephone or written communication. 10. Promote an effective use of resources for patients, customers and the facility with sensitivity to the cost of health care. 11. Ensure that patient rights are upheld. 12. Advocate for the lowest level of care consistent with patient needs. 13. Function as a resource for patient/families/significant others. Discharge Planning 1. Coordinate with the treatment team discharge plans that were identified by the treatment team. 2. Monitor the discharge planning activities. 3. Organize the use of resources to keep the patient as close to home as possible, provide liaison to aftercare providers and follow up after discharge to ensure efficacy of the discharge plans. Treatment Planning 1. Provide support and assistance to the patient and the patient's support system. 2. Review assessment information with admitting practitioners and treatment coordinator and formulate AXIS IV and V diagnosis (in consultation with admitting practitioner). 3. Plan an episode of care to identify services that will be provided if the patient is moved to a greater or less intensive level of care depending on the needs of the case. 4. Communicate with attending practitioner and treatment team, and other providers of service, to assure continuity of care and expedite the flow of services and transition between levels of care. 5. Provide feedback to the attending practitioner and treatment team members concerning continuing certification of days/services. 6. Communicate with external reviewers and referral sources. Conduct all needed external reviews and maintains documentation of all such interaction. 7. Ensure that third-party payors are notified of, or participate in, decisions about appropriate transitions between levels of care. Utilization Review 1. Assist potential patients in gaining access to federal and state support systems. 2. Consult with the business office and/or admission staff as needed to clarify data and ensure the insurance precertification process is complete. 3. Provide clinical precertification information to patients, managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days. 4. Coordinate with the insurance company doctor in appeals process and denials process. Notice At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.comor 1-800-852-3449.

Job Type:

Full-time Benefits:

401(k) 401(k) matching Dental insurance Disability insurance Health insurance Paid time off Vision insurance

Physical Setting:

Hospital Inpatient Experience:

Utilization review: 1 year (Required)

License/Certification:

RN or LCSW (Required)

Work Location:

In person