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                    Utilization Coord Non RN

                    MedStar Harbor Hospital
                    Baltimore, MD 21225
                    Full-time, Part-time
                    Similar jobs pay $26.50 - $36.43
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                    Job Description

                    • Job Summary
                      • Collaborates with the physician, social worker, and other members of the health care team to meet individualized patient outcomes. Performs pre-admission, concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Provides assessment, screening, evaluation, and disposition services for patients presenting with psychiatric concerns or illness in Emergency Department.
                    • Minimum Qualifications
                      • Education/Training
                        • Master's degree in Psychology or Social Work.
                      •  
                      • Experience
                        • 2 years psychiatric clinical experience in the assessment and disposition of behavioral health disorders.
                      •  
                      • License/Certification/Registration
                        • Licensure in the State of Maryland as required by discipline.
                      •  
                      • Knowledge, Skills & Abilities
                        • Ability to make independent clinical decisions. Ability to provide therapeutic interventions.Organization skills. Interpersonal skills, including verbal and written communication. Basic computer skills preferred.
                    • Primary Duties and Responsibilities
                      • Actively participates in ongoing professional enrichment and educational opportunities.
                      • Completes documentation relevant to activities. Complies with and ensures adherence to documentation standards. Complies with data collection, entry, and reporting requirements.
                      • Confers and collaborates routinely with the attending physicians to resolve problems relating to continued stay and medical necessity. Implements strategies to avoid denials including potential denial notification to attending physician.
                      • Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
                      • Coordinates admission to programs and services within Behavioral Health Services and associated programs. Provides and coordinates referrals to internal or external resources as appropriate.
                      • Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of psychiatric medical necessity.
                      • Participates in multidisciplinary quality and service improvement teams. Serves as a resource to all staff in areas of utilization review.
                      • Participates in the management of aggressive patients as needed to ensure the safety of patient, self, and others. Recognizes early warning signs of escalating behaviors and intervenes as appropriate.
                      • Performs concurrent reviews with managed care companies to obtain continued stay authorizations on the inpatient psychiatric unit. Interacts with and assists managed care company reviewers to facilitate appropriate care and ensure payment for services. Completes all forms and documentation necessary to support appropriate utilization of resources.
                      • Performs other duties as assigned.
                      • Provides clinical assessment, evaluation, and disposition of persons presenting with behavioral health concerns or illness in Emergency Department.
                      • Reports to managed care companies on patient discharges with information on aftercare plans, discharge diagnoses, and medications.
                      • Serves as liaison to referral sources, outside agencies, third party payers, and other interested parties as appropriate and within limits of confidentiality.
                    About MedStar Health
                    MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.
                    Posting ID: 559918011Posted: 2020-07-14