Utilization Review Coordinator
Company: Oceans Healthcare
Location: Broussard
Posted on: May 13, 2022
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Job Description:
The Utilization Review Coordinator is responsible for management
of all utilization review and case management activities for the
facility's inpatient, partial hospitalization, and outpatient
programs. Conducts concurrent reviews of all medical records to
ensure criteria for admission and continued stay are met and
documented, and to ensure timely discharge planning. Coordinates
information between third party payers and medical/clinical staff
members. Interacts with members of the medical/clinical team to
provide a flow of communication and a medical record which
documents and supports level and intensity of service rendered. All
duties to be done in accordance with Joint Commission, Federal and
State regulations, Oceans' Mission, policies and procedures and
Performance Improvement Standards.
Essential Functions:
Qualifications/Skills:Must have excellent assertive communication
skills. Knowledge and in-depth understanding of CD-psych treatment
and discharge planning process. Must have good writing and
composition skills. Must have good understanding of regulatory and
fiscal reimbursement and utilization review as a primary component
of patient care. Must demonstrate strong patient advocacy skills.
Must be able to organize and prioritize high volume workload. Must
be able to analyze and utilize data and systems to provide
individualized quality treatment in a cost-effective manner. Must
be able to function with minimal supervision. Therapeutic
Intervention De-escalation Education required. Must have ability to
maintain overall good work attitude and interact cooperatively and
professionally with other staff members and third party payers to
achieve mutually beneficial outcome. Must possess basic competency
in age, disability, and cultural diversity for needs of patients
served and ability to relate to patients in a manner sensitive to
those needs. Must successfully complete CPR certification and an
Oceans approved behavioral health de-escalation program.
Work Environment:Subject to many interruptions. Occasional pressure
due to multiple calls and inquiries. This position can be high
paced and stressful; must be able to cope mentally and physically
to atmosphere. Work requires spending approximately 90% or more of
the time inside a building that offers protection from weather
conditions but not necessarily from temperature changes.
Keywords: Oceans Healthcare, Lafayette , Utilization Review Coordinator, Other , Broussard, Louisiana
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