UTILIZATION MGMT COORD BEHAV
Loyola University Health System

Employment Type:
Full time
Shift:

Description:

Reporting to the Executive Director of Behavioral Health Services coordinates the utilization management activities for the Department. Reviews and assesses the appropriateness of patient admissions and continued stays as specified by the Utilization Review Plan and follows through accordingly. As a member of the Behavioral Health Interdisciplinary Team provides leadership and guidance in patient treatment planning and the discharge process.

Operations: 1)Reviews admissions and continued stays as specified by the Utilization Review Plan, determining the appropriateness of the hospitalization. 2)Performs concurrent chart reviews for performance improvement, risk management and other entities as deemed appropriate. 3)Communicates the appropriate information internally and to State, Federal and third-party commercial payers as necessary. 4)Communicates with physicians and staff to ensure that initial and continued stays are met. 5) Coordinates the physician peer review process. 6)Maintains payment denial data, completes retrospective reviews and submits denial appeals. 7)Conforms to the established Standards of Behaviors. 8)Other duties as assigned.

Reporting: 1)Collects data, prepares and submits reports as required by the Medical Staff Office, Department of Psychiatry, the Department Performance Improvement Committee and Hospital Quality Management Department. 2)Records, collects, trends and submits data/reports to internal and external entities. 3)Collects data and refers cases as indicated to the Department of Psychiatry

Education: 1) Educates and works with staff and physicians to ensure that documentation is complete, timely and effective. 2) Provides leadership and guidance to the interdisciplinary team regarding patient treatment plan staffings and documentation. 3) Participates in Performance Improvement activities and Department Committees. 4) Remains informed of developments in the area of expertise. 5)Participates in educational programs and activities such as conferences, workshops, interdisciplinary professional meetings and self directed learning. 6)Demonstrates active participation and networking in professional health care organizations and community organizations/services.

Planning: 1)Assists in the establishment of utilization management policies and procedures and evaluations 2)Updates existing programs at least annually.

Position Requirements:

Minimum Education:

Required: Masters Degree

Preferred: N/A

Specify Degree(s): Behavioral Health field

Minimum Experience:

Required: 1-2 years of previous job-related experience

Preferred: N/A

Details: Minimum two (2) years of experience in acute patient care in a Behavioral Health setting.

Licensure/Certifications:

Required: Licensed Clinical Social Worker State of Illinois

Other: Knowledgeable in Managed Care Organizations and procedures.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.