Oasis Behavioral Health
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Utilization Review Assistant (UR Coordinator) FT
at Oasis Behavioral Health
Perform pre-certification and negotiate continued stay with third party payers in a professional manner.
Gather data to support case management activities, including presentation of gathered data and case notes.
Verbally present knowledge of cases and the needs of third party payers in a timely manner.
Assist in admissions review, concurrent reviews and discharge planning.
Assist physician in peer review by serving as information resource, gather data to support review and schedule peer review.
Keep leadership advised of status of current patients, in regard to utilization activities through timely documentation and participate in performance improvement activities.
Coordinate with clinical team for discharge planning, maintain CRM database with discharge information and follow up.
Perform other functions and tasks as assigned.
High school diploma or equivalent required. Master’s degree in related Social Service field. Knowledge of various community and agency resources, business medical terminology, legal issues and confidentiality.
Current certification as Registered Addiction Specialist, certified Substance Abuse Counselor or similar certification preferred.
ADDITIONAL REGULATORY REQUIREMENTS:
Under the supervision of the Utilization Review Director, the Utilization Review Coordinator enhances and assists in the maintenance of high quality care, cost-efficient and effective utilization of the facility resources. Performs utilization review functions as mandated by JCAHO as well as private insurance groups under contract with Oasis.
Staff will wear Oasis Behavioral Health or other approved identification badge at all times.
Ability to understand and comply with government, regulatory, and hospital rules.
Under Federal Confidentiality Laws, employees of this agency may not disclose information about clients or employees to anyone outside this organization without the person’s prior written consent and may not disclose this information to persons within this Agency except on a “need to know” basis. This includes any identifying information concerning current, past or prospective clients or employees.
Presents behaviors and actions which maintain and enhance the hospital’s credibility, integrity and positive image. Demonstrates behaviors and actions which support the mission, goals, and operations of the hospital and which contribute to continuous performance improvement. Does not talk about personnel, company, or patient issues in public areas, or when off-duty.