Job details
Job type full-time
Full job description
Northern light acadia hospital
Department: utilization management
Position is located: acadia (remote)
Work type: full time
Fte: 1.000000:
Work schedule: 8:00 am to 4:30 pm
Summary:
The utilization management associate works within a fast-paced, high productivity office environment as a key member of a multidisciplinary teamThey are skilled at communication, organization and problem-solving abilitiesThe utilization management associate assesses utilization of hospital services for appropriateness of level of care, obtains required authorizations, participates in interdisciplinary meetings as a patient advocate and works with treatment teams to educate on documentation that meets hospital level of care criteriaThey build excellent working relationships with payor/insurance representatives to support the required authorization/billing processesS/he works as a direct support to the supervisor of utilization management and performs duties in accordance with the northern light acadia hospital um plan and established criteria.
Responsibilities:
Departmental
Conducts daily distribution of new admissions by evaluating current case loads of utilization management associates.
Completes daily review of census and tracks length of stay outliers on the um daily update.
Attends and participates in interdisciplinary meetings as a patient advocate while facilitating collaboration for process improvement, problem resolution and prevention of variation from the plan.
Conducts on-going and unit/program-based training of clinical staff on appropriate documentation of patient care.
Overall responsibility for inpatient utilization review for assigned patients.
Quality of service
Communicates with physicians, clinicians, clinical associates and external review organizations to advocate for patient access of benefits and appropriate level of care.
Notifies umdepartment supervisor of patterns (both positive and those that might reflect any reoccurring issues).
Promotes positive interaction between all departments and employees of nl acadia hospital.
Contributes to the partnership among caregivers, patients and families to provide safe and effective care.
Demonstrates positive and professional demeanor and attitude during all interactions while instilling confidence in system wide services and functions.
Continuedly seeking opportunities for improvement in outcomes and quality of care, monitoring for issues of risk management and maintaining a focus of decreasing costs.
Reviews
Conducts initial and concurrent reviews as established in the utilization management plan.
·completes on site and telephonic review from external organization as requested.
Documents information in the electronic medical record and enters data accurately in appropriate database.
Tracks and documents the progress in the patient’s plan of care through evaluating the effectiveness of meeting the desired goals and outcomes of the patient and the team.
Reviews record for appropriateness of medication, treatment plan and discharge planning based on diagnosis and standards of care.
Maintains detailed records of communication from payer/reviewers.
Initiates request for physician advisor reviews as outlined in the um plan.
Ensures discharge and transition planning is initiated by treatment teams for all admitted clients beginning at admission.
Proactively reduces the risk of denials.
Provides timely notification of denial of services to appropriate parties, documents steps and rationale for denial in cerner and verifies accurate letter format is utilized.
Facilitates clinical pertinence reviews on all patient admissions and continued stay, retrospective reviews, denial appeals, and completion of certification.
Other duties
Writes appeal letters as necessary to third party payors to appeal denied certification of medical necessity.
Documents data on appropriate report for commercial insurance authorization or denial, physician advisor requests, medicare reconciliation signature, and notice of noncoverage notification.
Completes weekly los report on assigned cases that are outliers.
Attends required in-service education programs.
Performs other duties as assigned.
Competencies and skills:
Essential:
Behaves with integrity and builds trust: acts consistently in line with the core values, commitments and rules of conductLeads by example and tells the truthDoes what they say they will, when and how they say they will, or communicates an alternate plan.
Cultivates respect: treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
Fosters accountability: creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviorsTakes appropriate ownership not only of successes but also mistakes and works to correct them in a timely mannerDemonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
No previous experience required.
Practices compassion: exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
Other information:
Qualifications / expectations:
Mature individual with a bachelor’s degree in a one of the human service fields, (social work, psychology, counseling, nursing etc.).
Experience in mental healthcare related field with a preference given to previous experience with utilization review and quality control systems.
A working knowledge of mental health/chemical dependency terminology and services necessary.
Excellent verbal and written communication skills including presentation skills.
Complete icare mandatory education on a yearly basis.
Attends all mandatory safety related education programs.
Follow safety procedures to prevent injury to self and others.
Carry assigned keys and wears hospital id badge at all times.
Refrain from the abuse of chemicals.
Value relationship building and collaborationMust be able to interact in a professional, positive and ethical manner with all levels of the organization and external community members.
Demonstrate ownership and accountability.
Credentials:
Education:
Essential:
Bachelor`s degree
Education equivalent experience:
Essential:
Bachelor’s degree in a one of the human service fields, (social work, psychology, counseling, nursing etc.).
Working conditions:
Essential:
Work with computers, typing, reading or writing.
Continuous sitting.
Continuous standing.
Northern light acadia hospital is an acute care, regional psychiatric hospital in bangor, maine that is a leader in the provision of tele-psychiatry services, including consultations to regional emergency departments and primary care practicesNorthern light acadia hospital offers innovative programming in the form of a behavioral home health, integrated behavioral healthcare in primary care practices, and a geriatric mood and memory clinic, which is involved in multiple clinical trials for promising alzheimer`s medicationsThe hospital is the sole corporate member of northern light acadia healthcare that provides a substance use disorder treatment program, case management services, and other outpatient mental health services in penobscot, waldo, and knox countiesNorthern light acadia healthcare is the sole member of restorative health, llc that operates an outpatient mental health clinic in bangorNorthern light acadia hospital is a member of northern light health, an integrated statewide health delivery system that is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our stateNorthern light health offers a broad range of providers and services, including nine hospitals, primary care and specialty physician practices, long-term care, home health and hospice agencies, and emergency ground and air transport.
Bangor, maine is a vibrant small city with easy access to maine`s spectacular coast, mountains, and lakesSchools rank among new england`s best with the flagship campus of the university of maine located in the neighboring town of oronoBangor serves as the regional hub for medicine, the arts, and commerceBangor international airport offers direct and one-stop service to most major destinations.
