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Company: MedStar Health
Location: Baltimore, MD
Career Level: Entry Level
Industries: Not specified
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Description

General Summary of Position
Collaborates with and assists the multidisciplinary team to meet individualized patient outcomes. Performs admission and subsequent concurrent reviews based on approved screening criteria knowledge of insurance coverage and communication with the third-party payers.

Primary Duties and Responsibilities


  • 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.
  • Actively participates in ongoing professional enrichment and educational opportunities.
  • Collaborates with and assists the multidisciplinary team to meet the patients' continuing health needs in a high quality cost-effective manner. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient LOS insurance and discharge needs. Integrates and evaluates discharge planning needs with multidisciplinary team to ensure a positive patient outcome.
  • Collects quality improvement data in accordance with approved indicators. Recognizes potential problems and makes referrals to quality improvement risk management safety infection control and other departments as appropriate.
  • Confers and collaborates routinely with the physician advisor division chiefs and attending physicians to resolve problems regarding acuity and level of care. Collaborates with outpatient providers to provide continuum of care for community resources.
  • Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity.
  • Identifies insurance information obtains authorization communicates with financial counseling and assigns appropriate length of stay for admission. Identifies in network providers for discharge planning needs and facilitates appointments. Collects data in collaboration with Case Management to support appeal process.
  • Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third party payers according to policies and procedures. Communicates utilization plans to multidisciplinary team.
  • Ongoing collaboration routinely with Social Work and physicians for continued update and revision of discharge plan to provide appropriate utilization of resources and to insure optimal patient outcomes.
  • Performs admission and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviews to facilitate appropriate care and ensure payment for services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources. Collects data in collaboration with third party payers to insure appropriate use of resources.
  • Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services staff meetings orientation and formal educational offerings.
  • Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
  • Participates in multi-disciplinary quality and service improvement teams.
    • Minimal Qualifications
    Education
    • Associate's degree in Psychiatry or related field required or
    Experience
    • 5-7 years Clinical experience in acute care setting preferred and
    • 1-2 years Experience in utilization/discharge planning. required
    Knowledge Skills and Abilities
    • Verbal and written communications skills.
    • Organizational and problem-solving skills.
    • Working knowledge of various computer software.

    This position has a hiring range of

    USD $20.57 - USD $36.27 /Hr.


     Apply on company website

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