Utilization Management Coordinator

Laurel Heights Hospital is a 112-bed facility located in Atlanta Ga. We are dedicated to providing youth with compassionate mental health treatment that encourages self-responsibility and personal growth. We provide psychiatric treatment to children and adolescents that present with a broad range of psychiatric, behavioral disorders and autism. A clinically skilled multidisciplinary team works to partner with the youth and family to accomplish their goals in a supportive and therapeutic environment.

Much more online at http://www.laurelheightshospital.com

The Utilization Management Coordinator is responsible for completing and submitting medical necessity precertification and concurrent reviews to multiple insurance providers in an Acute/Inpatient and Residential hospital setting. Knowledge of behavioral health and third-party reimbursement, knowledge of InterQual is preferred but not required. Must be able to work independently in presenting information obtained from Admissions Department, Clinical Department, and in gathering patient information for concurrent reviews. Maintains direct communication with Director of Utilization Management and Director of Admissions to inform of impending denials to proactively assist client and family with appropriate clinical decisions. Documents the certification results in a web based corporate database. Familiarity with medical terminology, diagnostic terminology, diagnostic terms and treatment modalities; knowledge of medical record keeping; understanding of medical necessity, understanding of admission and discharge function; strong interpersonal, organizational, evaluative, and time management skills; familiarity with applicable standards and regulations; flexibility; extreme attention to detail; able to comprehend psychiatric evaluations, consults, labs results, etc.; responsiveness to deadlines; assertiveness, persistence, and persuasiveness; able to work with minimal direction or supervision.

ESSENTIAL DUTIES AND RESPONSIBILITIES, include, but are not limited to, the following:

• Completes precertification reviews for patients approved for admission and completes concurrent reviews.
• Completes precertification and concurrent/clinical reviews in a timely manner.
• Communicates pertinent information to UM Director, Admissions Director, and managers/directors in timely manner.
• Documents precertification and review completion and accompanying information in web based corporate databases.
• Able to communicate effectively in English through verbal and written means.
• Respects confidentiality of patient information.
• Maintains a courteous and professional manner in dealing with patients, family members, visitors, physicians, and co-workers.
• Shows a positive attitude toward work schedule, assignments, and daily tasks.
• Attends mandatory in-service education programs and shows evidence of educational growth. Stays current with Handle with Care, CPR, and Healthstream.
• Accepts assignments as commensurate with knowledge and experiences.
• Presents professional appearance in dress and grooming and wears identification badge and follows dress code.
• Handles emergencies, pressures, and stressful situations in a calm and professional manner.
• Able to organize tasks, follow through with assignments, and sets priorities.
• Conforms to facility policy regarding notification of absence or tardiness and PTO (use of sick time, vacations, and holidays).
• Demonstrates knowledge of and performs within limits of policies and procedures.
• Understands individual responsibilities for safety and infection control and carries out responsibilities as defined in policy and procedures manuals.
• Demonstrates knowledge and location of all admission records, intake folders, UM folders and drives, and current clinical and medical charts.
• Demonstrates knowledge of state licensing regulations, contractual requirements, CARF standards, HIPAA policy, ordinances, laws, and other regulations required of his/her position and acts consistently and in obedience to same.
• Reviews medical/clinical record documentation on insurance residents.
• Participates actively in UM meetings, UM reviews, treatment teams, and general staff meetings as needed.
• Performs other duties as assigned.

1. EDUCATION and/or EXPERIENCE

Masters preferred with major academic studies in psychology, social work, or health/counseling field; including appropriate on-the-job training and experience to meet the duties and responsibilities of this position.  Must have previous experience working in a clinical setting providing direct patient care and/or previous admission experience and/or utilization management experience. Must have the ability to complete precertification and concurrent reviews.

1. CERTIFICATES, LICENSES, REGISTRATIONS

None required but preferred.

1. LANGUAGE SKILLS

Ability to read, analyze, and comprehend psychiatric evaluations, consults, lab results, etc. Ability to effectively present information and respond to questions from directors/supervisors, clients, customers, and the public.

1. TECHNICAL SKILLS

Working knowledge of personal computers, electronic data processing equipment and related spread sheet and word processing software and applications. Ability to understand detailed written or oral instructions. Have effective organizational and negotiating skills.

1. REASONING ABILITY

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

1. PHYSICAL DEMAND

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; stoop, kneel, crouch, or crawl; and taste or smell. The employee must frequently lift and/or move up to 10 pounds.

1. WORK ENVIRONMENT

The work environment for this position is an acute and residential treatment facility setting for adolescents. While performing the duties of this job, the employee will be exposed to residents who may ask inappropriate personal questions, display socially unacceptable personal behaviors, use profanity and sexually explicit phrases, make insulting remarks or threats regarding appearance, age, sex, or race, and exhibit defiance, dishonesty, and assaultive or self-destructive behaviors. The employee is occasionally exposed to outside weather conditions. The noise level in the work environment is usually quiet to moderate.