What are the responsibilities and job description for the Utilization Review Analyst position at EAGLEVILLE HOSPITAL?
Job Details
Description
Job Summary:
Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.
Job Duties and Responsibilities:
- Reviews admissions to determine medical necessity and appropriateness of treatment.
- Interviews patients to obtain justification of treatment.
- Secures necessary data for extended stay reviews.
- Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
- Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for Medicare, self-pay and private (non-pre-certification) insurance companies.
- Communicates all extensions of treatment to clinical teams and Director, Concurrent Review.
- Notify clinical teams of need for current documentation.
- Refer cases to Director, concurrent Review when appropriateness of and necessity of extended stay is questionable.
- Able to take & transcribe minutes for the Utilization Review Committee Meeting
- Attend appropriate daily treatment team meeting
- Other Duties and Responsibilities
Qualifications
Education/Experience:
• 3-5 years' experience in Utilization Review or related position in a healthcare setting.
• Bachelor of Science in Behavioral Health, Sociology, Counseling or RN is preferred.
• Intermediate knowledge of computer skills and the internet, Microsoft Office experience, Excel- Intermediate level, Word- Intermediate level.
• Knowledge of medical terminology, medical record format and content.
• Knowledge of local, state and federal regulations.
• Knowledge of medical terminology, appeal and denial process, composition of medical records.
• Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources
