Job Description

Job Description

PRN Utilization Review Coordinator

Haven Behavioral Hospital of Reading is seeking caring and compassionate people to join our team of devoted healthcare professionals. 

Why Haven of Reading? 

Haven Behavioral Hospital of Reading is an 86 acute-care Joint Commission Accredited psychiatric hospital that offers care for adults dealing with mental health conditions and co-occurring disorders. We are dedicated to partnering with individuals, families, and communities to improve the lives of patients through the delivery of high-quality, specialty behavioral health services.

POSITION SUMMARY:

This person will develop and implement systems for the authorization, concurrent and retrospective review of inpatient admissions and services. Supervises staff and the quality, efficiency and effectiveness of services delivered.

• Obtain authorization for each admitted patient.
• Review and monitor each step of the authorization process to proactively identify potential problems.
• Interact with physicians and therapists constantly to assure patient assessment and treatment plan is accurately and consistently reflected in facility documentation.
• Track enrollment status continuously to act on changes and initiate retrospective review as necessary.
• Monitor staff communication with external representatives to ensure it is professional and thorough.
• Maintain cumulative documentation regarding actions initiated by staff and self. 
• Conduct reviews to ensure that services and documentation conform to the facility protocols, applicable laws and regulations and the requirements of funding sources.
• Collaborate with physicians, nurses, and therapists regarding medical necessity for stay, appropriateness of treatment and estimated length of stay. 
• Attend meetings daily to obtain and present information on patient status, care and stay.
• Communicate authorization status, issues or problems to appropriate staff.
• Obtain and maintain authorization for each patient. Problem-solve issues relating to stay or service. 
• Respond quickly and effectively to requests for information. 
• Nurture positive and professional relationships with external sources.
• Minimize the number of appeals.
• Monitor the authorization for continued stay for each patient, and initiate the appeal process when payment for services is denied due to clinical concerns.
• Coordinate the provision of complete and timely documentation to support the appeal.
• Obtain successful resolution of appeals.

EDUCATION: Bachelors Degree in Behavioral Health field or equivalent experience.

EXPERIENCE: Two years clinical experience in a psychiatric setting. Knowledge of medical terminology and insurance and billing practices is essential to this position.

Haven Behavioral Healthcare is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse workforce.

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