Works under the supervision of the Behavioral Health Administrator and is primarily responsible for the completion of the utilization review process and completing initial and concurrent reviews with third party payers.Additional responsibilities include:monitoring the progress of treatment goal achievement; liaison between payer, patient, family, physician and team members to coordinate and integrate services; assists with the discharge/dispositional needs of the patient; acts as a clinical/educational resource for third party payers, patients, families, treatment team members and community agencies involved in the scope of the clinical services provided by the Behavioral Health Hospital
1.Monitors the development and goal achievement of an individualized plan of care.
2.Identifies, secures, and coordinates the services and resources to implement the patient’s plan of care.
3.Identifies/investigates potential sources of reimbursement, making referrals to the appropriate Medical Center department or community agency.
4.Interacts with Insurance companies, Third Party Payers, LME and others in order to facilitate insurance approval.
5.Provides documentation to reflect patient/family assessment of plan of care, teaching, discharge planning and reimbursement/third party payer status.
6.Completes all necessary utilization review processes in a timely fashion.
7.Acts as a clinical/educational resource for patients, families and team members and third party payers.
8.Organizes and performs work responsibilities effectively and efficiently.