About this opportunity
Daymark Recovery Service lists this PRN Utilization Review Admin opportunity in erwin, North Carolina. Review the employer’s description below for duties, qualifications and application requirements.
Job description
PRN Utilization Review AdminGood Hope Hospital - Erwin, NC 28339DescriptionOur mission is to inspire and empower people to seek and maintain recovery and health. Daymark Recovery Services, Inc. is a mission driven, comprehensive community provider of culturally sensitive mental health and substance abuse services.Comprehensive Benefits PackageMedical, Dental and Vision InsuranceHealth Spending AccountCompany-Paid Life InsuranceShort Term Disability401(k)Paid HolidaysPaid Vacation and Sick LeaveEmployee Assistant ProgramReferral Bonus OpportunitiesExtensive Internal Training ProgramPay Scale: $ /hr. salary based on education and experienceSummary:The Utilization Review Coordinator initiates pre-certification calls for private insurance and managed Medicare and Medicaid plans and provides concurrent reviews throughout the patient stays.Essential Duties and Responsibilities:Tracks utilization review outcomesAssess and reassesses the quality of patient progress notesMaintains insurance contact informationManages insurance appeal process and work with the client hospital's denial management coordinatorCommunicates treatment team recommendationsAttends treatment team meetingsParticipates as an active member of the interdisciplinary teamAddresses issues in a timely manner and informs Program Director of progressProvides ongoing education to management and staff for performance improvementContinuous education of legislative and insurance changes in regard to continued stay requirementsProvides resources and suggestions to third party payors regarding aftercare and discharge continued carePerforms as liaison with appropriated interested parties and physicians through the utilization processResponds to requests for general information about the unit's treatment program, and provides information about appropriate topics in response to community requests. Informs Program Director and Nurse Manager of any issues identified by insurance reviewersCoordinates treatment with other health and social agenciesIdentifies areas needing improvement and utilizes the facility performance improvement processDisseminates pertinent findings/data to referral sources as neededStays informed on all clinical services and program changes in order to appropriately represent payor sourcesCompletes all pertinent staff competenciesAll other duties as assigned by supervisorQualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.Highly motivated and resilient professionalStrong negotiation skillsDemonstrated leadership and supervisory experienceDemonstrated ability to positively lead change and gain resultsSome knowledge of or willing to learn clinical practice modelsDemonstrated ability to understand economic, business and operational factorsPreceptor and teaching experience helpfulStrong critical-thinking/problem-solving skillsProven conflict management/resolution skillsHigh professional ethics and standardsStrong team player and team building skills; ability to collaborate with all levels and areasStrong presentation skillsProven relationship-building and management skillsAbility to effectively and positively influence and persuadeEducation and/or Experience: A Bachelor's Degree from an accredited college with a major in chemical dependency, psychology, social work, counseling, nursing or other related field is preferred; and/or Minimum three years' of experience in a similar position and/or industry.
Worksite address
erwin, NC, 28339, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.