Acadia Healthcare Utilization Review Clinician (Contingent) in New Baltimore, Michigan
ESSENTIAL JOB RESPONSIBILITIES:
Obtain pre-certification information from A&R office/UR Supervisor, maintains a log of updates, and follows up with the Admissions Department regarding third party payer benefits/issues.
Oversee & Contacts third party payers to obtain pre-certification of admissions as needed.
Coordinates continued certifications with the physician and third party and protocol.
Assures that evaluations, examinations, histories and tests are completed within the hospital prescribed time frame and protocol for self and all other UR staff.
Attends and or coordinates attendance by UR staff at weekly team meetings.
Continuously monitors reports and trends length of stay.
Monitors timeliness and accuracy of documentation, assures completeness, and documentation of medical necessity of care for all UR staff.
Ensures notification to the proper team members when treatment is not provided as planned or when documentation is lacking.
Meets regularly (as required) with the appropriated D.O.N. or Program Director to discuss program discharges.
Notifies appropriate parties of impending denial from a third party payer.
Conducts and supervises reviews of assigned admissions for appropriateness of care at the acute level.
Conducts and oversees concurrent reviews on assigned patients.
Maintains a log of all reviews completed and documentation requests.
Requests consultation with the appropriate physician advisor for assistance as needed.
Serve as the primary liaison to on-site external reviewers.
Complies with all HOH policies and procedures, especially those regarding patient confidentiality.
Employee will be required to perform other job related duties as assigned by management.