General Statement of Duties: The Utilization Management Coordinator coordinates and monitors the daily utilization management function of the Psychiatric Unit, ensuring the appropriate allocation of hospital resources while maintaining quality of patient care. The Utilization Management Coordinator collaborates with other members of the behavioral health and multidisciplinary team to advocate for patients and families within the health care continuum. The Utilization Management Coordinator ensures regulatory compliance with CMS guidelines and coordinates utilization management processes from numerous payer sources. The Utilization Management Coordinator assists in managing length of stay and insuring documentation of medical necessity for admission and continued stay. Essential Job Functions: 1. Assesses charts to review discharge needs of all high-risk patients (and others referred). 2. Works collaboratively with the interdisciplinary health care team to identify patients’ treatment goals and progress toward achieving desired outcomes. 3. Performs admission and continued stay reviews. Provides clinical information to payers upon request for certification and reimbursement of care. Discusses alternate level of care with physician. Refers cases not meeting acute care criteria to Physician Advisor as needed. 4. Facilitates and or provides education of hospital staff, and physicians for purposes of efficient resource utilization 5. Keeps current of requirements by JCAHO, HCFA and other state/federal agencies on provision of care, planning and documenting. 6. Tracks resource statistics to identify improvement opportunities. Attends medical staff and other hospital committee meetings to report findings.
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