FUNCTION The UR Coordinator assists in the overall utilization management process to ensure that services and programs meet accepted professional standards and are utilized appropriately. Reports as scheduled.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
1. Establishes and carries out program of admission and continued stay review.
2. Performs external concurrent review as requested by managed care entities or preferred provider contractual agreements. Acts as a facility liaison with managed care firms.
3. Tracks all facility external concurrent reviews. Identifies any problems and communicates with appropriate staff.
4. Completes provider contracts.
5. Establishes and carries out a program of review on an ongoing basis on 25% of the patient population.
6. Reports findings and recommendations to the Quality Management Director, Executive Director, and Clinical Director as indicated.
7. Incorporates review findings and outcomes to the Clinical Care Committee as indicated.
8. Provides support, as needed, for precert specialist.
9. Reports for duty as scheduled.
10. Participates in Performance Improvement Initiatives.
QUALIFICATION REQUIREMENTS: To perform this job successfully an individual must be able to perform each essential duty satisfactorily.
EDUCATION OR EXPERIENCE
The UR Coordinator will either be a graduate of an accredited school of nursing and hold a valid RN license to practice in NYS or be license eligible and/or have at least three years experience in case management, utilization management or chemical dependency.
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