Director of Utilization Review Services in Windsor, MO at Compass Health Network

Date Posted: 8/30/2019

Job Snapshot

Job Description

Compensation: 23.00

POSITION PURPOSE

Responsible for Supervision of Utilization Review functions, including external communications with Utilization Review Agencies. Responsible for internal Utilization Review Plan functions.

ESSENTIAL FUNCTIONS – JOB SPECIFIC

• Conducts internal admission/concurrent reviews daily
• Supervises other personnel employed in the Utilization Review department
• Representation of the hospital in retrospective appeal process/R.A.C. audits
• Conducts appeals of admission and continued stay denials
• Provides concurrent written documentation for treatment team members regarding status of payers
• Contacts physician/therapist for daily progress reports on non-certified days
• Reviews status of renew admit orders daily, following up with nursing staff when necessary to obtain orders
• Communicates with review company supervisors regarding issues between company review staff and ROH review staff to resolve differences
• Prepares and submits monthly reports of certification and continued stay reviews, length of stay approved or denied. These reports are submitted to the Governing Body and UR committee monthly and quarterly
• Attends P.A.C.T. meetings and participates in goal directed problem activities
• Attends daily meeting with Physicians and others regarding status of pt. issues of denials/placement, etc Coordinates required medical care evaluation studies
• Coordinates the Utilization Review Committee agenda
• Other duties as assigned

ESSENTIAL FUNCTIONS – COMPANY WIDE

• Regularly attends work except for approved absences
• Attends all training as required
• Maintain professional, “champion” behavior
• Provides quality customer service
• Provides services with a commitment to service excellence
• Works in a way that exhibits a commitment to personal excellence
• Team Oriented and Values Diversity

SUPERVISORY RESPONSIBILITY

• Oversee day to day operations and tasks of supervisees
• Complete performance development/AIM process
• Timecard Management – Manages time sheets
• Ensures progress and development is made toward departmental strategic plan goals

 

Job Requirements

EDUCATION

• PN (Practical Nursing) degree required
• Associates/Bachelor’s degree preferred

WORK EXPERIENCE

• At least one (1) year of psychiatric experience preferred

LICENSURE/CERTIFICATION

LPN valid in Missouri

 

Compass Health is an Equal Opportunity/Affirmative Action Employer and an E-Verify participant.