Utilization Management Coordinator
现任圣弗朗西斯员工 - 请点击这里登录和申请。本职位是欧洲央行的地位需要根据部门所需每月工作时间最低数量；提供限额福利。可变可变时间表和小时。工作总结：在医院和治疗团队进行患者审查，接受各种护理水平并获得必要服务以及适当放弃计划期间提供行政和临床支持.UM 协调员参与治疗团队，与提供者沟通补偿问题的细节；参与患者护理委员会进行病人护理审查，以及利用情况审核工作人员委员会，提供数据并为内部流程的改善做出贡献。为实现 UR 目标所需的人员教育提供。最低教育：已完成国家护理局批准和验证的护理学校的基本专业课程，并且持有或有权获得社会工作，咨询或相关行为健康领域的文凭或士学位。许可证，注册和/或认证：有效的多州或俄克拉荷马州注册护士许可证，临床社会工作者 (LCSW),专业顾问 (LPC) 执照，婚姻和家庭治疗师 (LMFT).工作经验：在行为健康保健方面有3-4年的相关经验，其中一部分可能是行为卫生管理服务方面的经验。知识，技能和能力：使用微软 Word,Excel 和 Access 的实操了解，以便用于编写信件和报告。有效的人际交流，书面和口交往技巧。集成数据分析以发现事实或发展知识，概念或解释的能力。能够有效和高效地组织工作和优先考虑工作。在对数值数据的检查中，根据需要进行细节定向的能力。将临床病例数据合成简洁总结的能力。基本功能和责任：满足审查间隔的时间要求，提供获得授权所需的临床信息。迅速响应授权机构需要进一步详细信息。参与治疗团队或患者护理委员会，提供有关选择级别的资格，福利和标准的信息。寻求用于提供医疗信息。
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This position is ECB status – requires a minimum number of worked hours per month as needed by the department; limited benefit offerings.VariableVariable Schedule and Hours.
Job Summary: Provides administrative and clinical support to the hospital and treatment team throughout the review of patients, their placement in various levels of care and their receipt of necessary services and appropriate discharge planning. UM Coordinators participate in treatment teams, communicating with providers the details of reimbursement issues; also participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal processes. Provides staff education as needed to further the goals of UR.
Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom or Master's degree in Social Work, Counseling or related behavioral health field.
Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License, or Clinical Social Worker (LCSW), or Professional Counselor (LPC) license, or Marriage and Family Therapist (LMFT).
Work Experience: 3 - 4 years of related experience in behavioral health care, part of which may be experience in Behavioral health managed care.
Knowledge, Skills and Abilities: Working knowledge of Microsoft Word, Excel and Access as might be used in the preparation of correspondence and reports. Effective interpersonal, written and oral communication skills. Ability to integrate the analysis of data to discover facts or develop knowledge, concepts or interpretations. Ability to organize and prioritize work in an effective and efficient manner. Ability to be detail oriented as required in the examination of numerical data. Ability to synthesize clinical case data into concise summaries.
Essential Functions and Responsibilities: Meets time requirements for review intervals, supplying the required clinical information to obtain authorization. Responds promptly to authorizing entity's need for further detail. Participates in treatment team or Patient Care Committee, providing information about eligibility, benefits and criteria for the selected level of care. Seeks treatment information for use in providing reviews for authorization of services. Contributes to discharge planning. Participates in quality of care process improvement. Identifies QI Triggers for individual patient situations, reporting them promptly to the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager. Reviews eligibility and benefits of patients, matching the level of care utilization. Assures compliance with Managed Care Behavioral Health standards in the area of UM procedures and documentation to permit accreditation for Laureate and/or to maintain the delegation standards established by the managed care contracts. Investigates and prepares appeals for insurance companies, when denial of reimbursement is related to medical necessity or to other treatment issues. Participates in UM process improvement on an ongoing basis and participates in the UR Staff Committee's process improvement goals.
Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.
Working Relationship: Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.
Special Job Dimensions: None.
Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.
Pre-Arrival - Yale CampusLocation:
Virtual Office, Oklahoma 73105EOE Protected Veterans/Disability
Originally posted on Himalayas