Utilization Review Coordinator Job Vacancy in Pontiac General Hospital Pontiac, MI 48341 – Latest Jobs in Pontiac, MI 48341
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Company Name : Pontiac General Hospital
Location : Pontiac, MI 48341
Position : Utilization Review Coordinator
Job Description : GENERAL SUMMARY:Analyzes and evaluates admission information and concurrent clinical documentation to support admission and discharge planning.PRINCIPAL DUTIES AND RESPONSIBILITIES:1. Assesses clinical documentation based on recognized criteria.2. Contacts third party payers to communicate clinical information/complete pre-certification and re-certification parameters.3. Coordinates with clinical treatment team members to obtain information that supports sustaining admission or preparing discharge plans.4. Applies criteria for admissions to determine medical necessity and appropriateness of level of care and follows through on appeals for denied claims based on medical necessity.SUPERVISION: Reports to the Manager of Social Work and Discharge PlanningKNOWLEDGE, SKILLS AND ABILITIES: MINIMUM EDUCATION: High School DiplomaMINIMUM WORK EXPERIENCE: 1 to 2 years of experience in Utilization Review or Case ManagementCONTACT WITH OTHERS: Interpersonal, verbal and written communication skills to effectively interact with physicians, patients and other hospital personnel. Must be physically able to manage patients per CPI-Non-Violent Crisis Intervention approved techniques, using the least restrictive intervention.ANALYTICAL DEMANDS: TB Skin test and mask fit (immediate upon hire and annual). Fingerprinting (immediate upon hire). Comprehensive knowledge of health care practices in the acute care and outpatient settings. Understanding of reimbursement systems. Knowledge of computer applications (Microsoft word, Internet and Excel).WORKING CONDITIONS: PHYSICAL EFFORT: Required to walk, sit and stand for long periods of time. Must be physically able to manage patients per CPI-Non-Violent Crisis Intervention approved techniques, using the least restrictive intervention.WORK ENVIRONMENT: Work in well-lighted and well-ventilated environments.EQUIPMENT USED: Various medical equipment.Job Types: Full-time, Part-timePay: $18.00 – $24.00 per hourBenefits:401(k)Dental insuranceHealth insuranceLife insurancePaid time offVision insuranceMedical Specialty:PsychiatryPhysical Setting:HospitalSchedule:Day shiftMonday to FridayWeekend availabilityCOVID-19 considerations:The Hospital Adheres to All Current and Future Covid Mandates.Ability to commute/relocate:Pontiac, MI: Reliably commute or planning to relocate before starting work (Preferred)Education:High school or equivalent (Preferred)Experience:Utilization review: 1 year (Preferred)Work Location: One location
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