The Utilization Review Coordinator/Clinical Therapist is responsible for ensuring that financial benefits are maximized in the treatment and discharge planning for assigned cases through initial and continued stay reviews, prior authorization work for discharge services, effective liaison work and communication between business office and treatment team, support of the discharge plan, and active pursuit of appeals. As a Clinical Therapist you will be responsible for providing direct and indirect client care by providing psychotherapeutic services to clients and families. Serves as a member of the interdisciplinary team supporting the facility's treatment program and philosophy; serves as the primary liaison between the facility and outside agencies for discharge planning, abuse reporting, and continuum of care functions.. Additionally, the Utilization Review Coordinator / Clinical Therapist:
Conducts concurrent and extended stay reviews on assigned patients in a reasonable time frame, ensuring the information is presented in a concise, articulate manner.
Schedules upcoming reviews; notifies the attending physician of physician reviews and facilitates reviews if necessary.
Establishes a good rapport with third party reviewers while maintaining an advocacy stance on behalf of the client; submits any written materials requested by third party payers in a timely manner.
Provide group therapy sessions and be able to effectively manage group process to maximize therapeutic benefits to patients; conducts process and specialty groups as assigned.
Provides individual therapy patients, ensuring therapy interventions are directly related to treatment plan goals and objectives; meets with patients weekly to assess response to treatment, level of functioning and treatment needs; assists patients in setting appropriate goals; discusses ongoing discharge plan with clients as assigned
Provides weekly family therapy for all assigned cases that is consistent with the Treatment Plan's specification of frequency and content/goals
Complete outcomes studies, such as SARS , Family Functioning Assessment, and other assessment when appropriate
Is pro-active and independent in gathering information for reviews from the client record and takes the initiative to seek information from members of the treatment team if necessary.
Notifies all concerned parties when cases are denied, giving recommendation regarding viability of appeal; effectively coordinates collection of all pertinent data to support organization and patient's position; ensures appeals are prepared within the dictated time constraints.
Maintains accurate and current records on day's denied and current status of appeals; demonstrates effective written communication skills in formulating appeals.
Maintains appropriate records of the utilization review data and activities; updates patient accounting database daily with accurate discharge and certification information; ensures files and records are organized and thorough and easily accessible.
Participates in formulation of patient's treatment and discharge plans with other members of the treatment team.
Maintains on-going contact with insurance reviewers to maintain certification status by providing reviewing insurance with discharge information including outpatient appointments that the patient has post discharge.
Supports departmental goals by attending and participating in department meetings and offering ideas and suggestions regarding goals and objectives.
Completes BPRS at admission and discharge.
Facilitates timely referrals to alternate levels of care and assists family and/or guardian with completion of applications.
Communicates with referral providers about new referrals and ensures that the facility has all necessary information to consider a referral; assists with ensuring that all receiving providers have all necessary clinical materials and information.
Documents case management contacts in progress notes, communicates with therapists/treatment team about contact and updates on the status of discharge planning.
Ensures the 24 hour post discharge requirement is met regarding passing on treatment and discharge information to the next provider.
Works with involved agencies by arranging and participating in multi-agency meetings as needed to facilitate a smooth discharge.
Establish prior authorization, travel, insurance application, etc. is coordinated for a timely discharge.
Maintains a shared file where information is updated to review status of faxes, referrals, etc; maintains contact with current providers to update them on the status of patient/course of hospitalization and to obtain information from provider to share with treatment team.
Participates in problem-solving regarding abrupt changes in discharge, coordinates and communicates the discharge plan with treatment team
Coordinates travel arrangements as directed by the therapists and communicates all information to therapists in a timely manner; contacts family with travel information and provides copies of necessary travel documents to family if directed by the therapist/treatment team.
Coordinates discharge appointments and communicates with treatment team.
Maintains documentation on all cases; ensuring progress notes on all case management contact/discharge planning efforts are completed no later than 24 hours after the contact; documents discharge appointments in the discharge paperwork.
Participates in community activities as requested by the Chief of Social Services to build relationships with community providers.
Serves as an effective team member and works closely clinical team.
Makes phone contacts with referral services and outpatient providers weekly.
Attends the Flash Meeting daily at 11:00 am
Assumes and/or performs additional duties as requested