UR Coordinator

York, PA
Sep 15, 2017
Sep 18, 2017
Accountant, IT
Full Time
Located in York, PA, White Deer Run of York is a co-ed residential drug and alcohol addiction treatment facility. Currently WDR has an opening for a UR Coordinator. The UR Coordinator assumes the operation of the Utilization Review Department and ensures that the Utilization Review requirements are established and adhered to. This position involves the management of statistics to examine trends in utilization of services and conducting pre-certifications and concurrent reviews with insurance companies. ESSENTIAL FUNCTIONS 1) Directs the supervision of UR Technician and assists with pre-certification and concurrent reviews. 2) Acts as a liaison between managed care organizations and facility clinical and medical staff. 3) Conducts clinical/medical reviews in accordance with certification requirement of each client's insurance plan. 4) Makes required phone and/or written contacts with managed care organizations to obtain necessary certifications and continuing care referrals. 5) Keeps accurate records of all contacts with external organizations/ persons (ie managed care, insurance companies, referrals, family members) who have legitimate interest in the client's care. 6) Conducts negotiation of rates with managed care companies under the direct input from the Clinical Director and reports successful negotiations to the Financial Office for appropriate billing of the claim. 7) Facilitates peer review calls between facility doctors and managed doctors including assisting White Deer Run doctors in the acquisition of pertinent clinical information. 8) Informs clinical/medical staff of any specific concerns that would extend or restrict a client's length of stay by the various managed care standards. 9) Provides information to managed care providers about alternative levels of care within the White Deer Run System and accurately promotes the utilization of these services. 10) Acts in coordination with the Clinical Director to constantly improve the quality of services provided to organizations that have provider contracts with White Deer Run. 11) Assists, whenever necessary, the Admission Department in pre-certification of care for clients planning to enter treatment. 12) Upon denial of certification, review chart with Clinical Coordinator, Director of Clinical Services and/or Administration and the Finance Office as on how to proceed with the appeals process. 13) Provides ongoing support and training for clinical/medical staff on documentation strategies, continued stay criteria and meeting specified charting requirements for various payers. 14) Monthly audit of clinical/medical charts with regard to timeliness of documentation, quality and appropriate level of care. 15) Assists Clinical Coordinators in developing a plan to strengthen documentation skills of clinical staff and to improve outcomes with the managed care concurrent review process. 16) Advises Clinical Coordinators/staff of continued stay criteria for various payers. 17) Conducts formal and informal inservice trainings for all clinical staff on the documentation of "medical necessity", which includes a working knowledge of the American Society of Addiction Medicine (ASAM) Patient Placement Criteria. 18) Acts as an active member of the Clinical Care Committee. 19) Attends multidisciplinary staff meetings each week. 20) Initiates Emergency Team Meetings. 21) Develops statistical and narrative reports on the utilization and quality of services provided at White Deer Run. 22) Gathers and reports on all discharge statistics as required by the Corporate Office, Executive Director, Administrator and Director of Clinical Services. 23) Monitors and reports on utilization of the Family Program. 24) Gathers and reports on non-routine discharges, including identifying trends that contribute to the AMA/AD rate. 25) Reports on all non-certified days, which includes the identified causes of non-certification and information in the appeal process. 26) Writes a daily report detailing all review calls of the previous business day to be reviewed in the Morning Report. Experience At least one year clinical experience in mental health or drug and alcohol setting. Education & Training Degree in related field preferred or a Licensed Practical Nurse or Registered Nurse in the field of addiction. Other Requirements Knowledge of medical terminology that is commonly used in mental health settings (ie psychiatric disorders and medication, detoxification signs and symptoms). Strong organizational skills. Good verbal and written communications skills. Ability to communicate effectively with patients and related to individuals of diverse backgrounds. Willingness to be flexible in adjusting to new and changing situations Company offers Benefits and PTO EOE DRUG FREE WORKPLACE Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. Qualifications Skills Behaviors Motivations Education Experience Licenses & Certifications