Job Description:

Job Posting Title

Utilization Review Coordinator

Agency

452 MENTAL HEALTH AND SUBSTANCE ABUSE SERV.

Supervisory Organization

Griffin Memorial Hospital

Job Posting End Date (Continuous if Blank)

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Full time

Job Type

Regular

Compensation

$21.63/hour (45,000/yr)

Job Description

Basic Purpose

Under general direction, reviews clinical documentation to screen for appropriateness of admission, continued stay criteria and special studies regarding delivery of care, treatment and services.  Coordinate the authorization and re-certification of services by external entities reimbursing the facility for care provided. 

Typical Functions

• Conduct admission reviews for each individual admitted for care using admission criteria to determine the necessity and appropriateness of admission. 


• Assign an estimated length of stay for each individual according to criteria and length of stay statistics. 


• Conduct continued stay reviews on all individuals who continue to receive services when the statistical length of stay is reached.


• Consult with the physician advisor concerning cases failing to meet established screening criteria and/or conformance with professional standards. 


• Collaborate with reimbursement, health information management and clinical staff to ensure appropriate authorization of services.


• Coordinate the authorization of admission and approval of continued hospital stay as needed by an individual’s pay source.


• Interact with external entities regarding the review of specific cases for medical necessity and appropriateness of care.  Consult with clinicians when there may be the potential to deny reimbursement for care.


• Conduct special studies as identified by the organization’s leadership.


• Maintain files of reviews conducted for easy retrieval in electronic systems.


• Compile a monthly report to clinical leadership about activities and concerns identified through reviews.

Level Descriptor

Education and Experience

Completion of a Baccalaureate Degree in social work, psychology, or related field from an accredited college or university.  One year of professional experience in a psychiatric setting OR a valid permanent OK license as a registered nurse as approved by the OK Board of Nursing and one year of experience in a psychiatric setting.

Knowledge, Skills, Abilities, and Competencies

Knowledge of behavioral health treatment and diagnosis.  Understanding of utilization review principles and practices and applicable standards, requirements, and laws; skill in clinical record review and effective communication with physicians, nurses, therapists, reimbursement personnel and insurance companies about care, treatment, and services provided; ability to work with office equipment including computers, copiers, fax machines, telephone, and calculators; computer skills utilizing a variety of software applications; must have a good and understanding of math and be able to generate accurate statistical reports; working knowledge of state and federal statutes related to mental health and confidentiality; organizational abilities and the ability to pay attention to detail.  Customer service skills and the ability to present information in a clear, calm, and accurate manner in both oral and written form.

Special Requirements

Additional Job Description

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current State of Oklahoma employees must apply for open positions through their Workday account. Go to Careers app on WD home screen>Click on 'Find Jobs-Internal State of Oklahoma'.

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