What are the responsibilities and job description for the Substance Abuse UR Coordinator position at Alpas Wellness?
Overview
We are seeking a dedicated and detail-oriented Coordinator to join our dynamic team. The Utilization Review Coordinator will monitor adherence to Alpas utilization review plan to ensure the effective and efficient use of treatment services and monitor the appropriateness of inpatient admissions continued stays.
Description:
1. Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of admissions.
2. Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
3. Coordinates and supervises the activities of the Utilization Review Department.
4. Calculates the lengths of stay and continued-stay days for patients.
5. Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or continued stay.
6. Assists the Utilization Review Team in the assessment and resolution of utilization review problems.
7. Identifies problems related to the quality of patient care and refers them to the Executive Director
8. Maintains communication with the Clinical Department to facilitate timely discharge planning.
9. Compiles monthly reports and statistics for presentation to the Leadership Team
10. Participates with the multidisciplinary team to evaluate, plan, and execute interventions appropriate to the management of the patient’s needs through the continuum of care.
11. Performs the utilization review function to ensure the accurate assignment and appropriate use of resources.
12. Conducts initial, concurrent, and retroactive reviews with payers.
13. Conducts denial appeals and sends follow up record request for approval
14. Works with Providers, Clinical and Nursing to ensure all documentation needs as met as required Comar, Insurance and TJC.
Join us in making a difference in the lives of our patients by providing exceptional coordination of care services!
Job Type: Full-time
Pay: $66,333.00 - $72,128.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Medical Specialty:
- Addiction Medicine
- Psychiatry
Schedule:
- 8 hour shift
- Day shift
- Weekends only
Ability to Commute:
- La Plata, MD 20646 (Required)
Ability to Relocate:
- La Plata, MD 20646: Relocate before starting work (Required)
Work Location: In person
Salary : $66,333 - $72,128