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.