Utilization Review Analyst
Description:
Job Details
Eagleville Hospital - Eagleville, PA
High School
None
1st shift
Health Care
Description
Job Summary:
Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.
Job Duties and Responsibilities:
Reviews admissions to determine medical necessity and appropriateness of treatment.
Interviews patients to obtain justification of treatment.
Secures necessary data for extended stay reviews.
Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for Medicare, self-pay and private (non-pre-certification) insurance companies.
Communicates all extensions of treatment to clinical teams and Director, Concurrent Review.
Notify clinical teams of need for current documentation.
Refer cases to Director, concurrent Review when appropriateness of and necessity of extended stay is questionable.
Able to take & transcribe minutes for the Utilization Review Committee Meeting
Attend appropriate daily treatment team meeting
Other Duties and Responsibilities
Qualifications
Education/Experience:
• 3-5 years' experience in Utilization Review or related position in a healthcare setting.
• Bachelor of Science in Behavioral Health, Sociology, Counseling or RN is preferred.
• Intermediate knowledge of computer skills and the internet, Microsoft Office experience, Excel- Intermediate level, Word- Intermediate level.
• Knowledge of medical terminology, medical record format and content.
• Knowledge of local, state and federal regulations.
• Knowledge of medical terminology, appeal and denial process, composition of medical records.
• Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources