This position collaborates with the patient, family, and members of the treatment team to ensure that the episode of care plan is being effectively implemented, communicated, and changed as needed. Supports the patient, family, and team in transitions and documents services and quality of care.
Perform pre-certifications, concurrent reviews, and discharges for inpatient and residential services.
Work with the Utilization Review team to assist with carrying patient cases requiring concurrent reviews with a variety of statuses on an intermittent and as needed basis.
Medicare patients will be tracked and certified promptly upon admission/review date.
Reviews may be live, phone reviews, fax in, or written form and paper reviews.
Be an interdisciplinary team member with the treatment team and physician.
Attend staffing meetings and communicate effectively to provide feedback regarding:
Status of the patient (i.e., insurance, self-pay, county indigent).
Be prepared for follow up on difficult cases with an understanding of the case.
Notification of upcoming reviews for the week with more than 24 hours when possible.
Be prepared to present necessary information to business office/administration as necessary.
Consult with treatment team, outside providers, or other agencies and facilities as required.