Position Title: Utilization Review Coordinator/ Social Services

Department: Utilization Review

Status: Full-time; Non-exempt

Shift/Hours of Work (if applicable): Days

Nature of Work: Duties include, but are not limited to: Prepares and maintains files on all in-patient and observation admissions; Review all insurance, Medicare and Medicaid admissions to be sure they meet criteria for necessity of admissions; Review all other admissions for discharge planning; Discuss with providers regarding insurance and Medicaid patient admissions that do not meet indicated criteria; Discuss with providers on Medicare patients meeting the two midnight rule; Discuss with providers regarding appropriate discharge planning; Perform confirmation of preadmission/preauthorization of admissions; Review necessity of admission for third party payers and provide information to third party payers as permitted by hospital policy. Responsible for delivery of discharge planning which begins upon admission. Ensures appropriate screening assessments are completed for transitional care needs and Long Term Care. Provides educational counseling as needed to ensure understanding of information. Performs QAPI for department.

QUALIFICATIONS:

Education: Associates degree or equivalent in Health Information Administration, LPN/RN or other related field.

Knowledge of medical terminology, regulatory agency standards and utilization review practices and procedures.

Knowledge of DSM IV and ICD 9 coding

Special Skills/Training: Excellent communication and presentation skills

Preferred previous UR training and/or experience with InterQual criteria