Ur Coordinator

Ergii•Los Angeles, CA

About The Position

The Utilization Review Coordinator is responsible for conducting or reviewing completed intake assessments with Axis 5 diagnosis upon patient admissions for Detox, Residential, PHP and IOP levels of care following ASAM criteria. The Coordinator assesses for crisis/risk situations that may arise during intake and communicates with the Executive and Program Director. The UR Coordinator collaborates with the admissions department to ensure potential admissions meet inclusion criteria for admissions to Resurgence. The UR Coordinator is responsible to complete concurrent review documentation prior to review date that assess individuals' current symptoms, treatment barriers, mental health and medical statuses. This position is the liaison with the Third Party Billing and UR Company that partners with ERG II and other managed partners

Requirements

At least 1 year experience working with Substance abuse population and/or Acute In-patient, Residential, PHP, IOP programs.
Strong professional references attesting to high degree of customer service, punctuality, and professionalism.
One year experience and knowledge in Utilization Review
Clean DMV record and/or in accordance with company insurance requirements.
Ability to follow instructions clearly and precisely while experiencing multiple competing demands for employee time
Current certification in First Aid/CPR
Experience with Crisis/Risk Management.
Knowledge of assessment, diagnosis, treatment planning, discharge planning and excellent documentation skills.
Knowledge of HIPAA
Current certification in First Aid/CPR
Health Screening Clearance
Knowledge of medical necessity for DTX, RTC, PHP, IOP levels of care

Nice To Haves

Prefers current certification or licensure (CADC, MFT, LCSW); minimum requirement of registered RADT-1.

Responsibilities

Conducts or reviews completed mental health intake assessment of clients within 24 hours of admission that assesses for social, legal, physical health, mental health, medications, and symptoms.
Collaborates with the VP of Compliance and Program Director when needed to manage crisis situations that may arise during the intake process.
Data entry and clinical documentation utilizing electronic medical records
Communicate with clinicians, nursing, medical and operations to ensure accurate and timely medical necessity documentation
Monitors and enters Daily UR log with updates from insurance case managers recommendations to ensure to capture documentation needed for reviews
Prepares prep cases for MD when MD has live reviews and schedules live reviews on MD calendar
Other duties as assigned
Monitor the quality of care, and the member's response to services and products delivered to determine if the goals of the plan of care are being achieved, whether those goals remain appropriate and realistic, and what actions may be implemented to enhance positive outcomes and promote optimal health.
Maintains tracking logs for chart audits and is responsible to ensure clinical staff is maintaining compliance.
Manages stressful situations calmly and rationally and identifies potential high-risk situations
Demonstrates an ability to effectively communicate in written documentation the status of the client
Begin treatment plan based on the BPS assessment and needs.
Attend weekly Clinical meetings, as needed.
Meet with clients to explain PTM cases and process, as needed.
Explain financial documents, as needed and review intake documents such as consents and admissions agreements for clients to sign.
Documents all client contacts and interactions
Other job duties, as assigned