Utilization Review Analyst
Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.
Position Summary
Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.
This position reports to the Utilization Review Director
Objectives / Responsibilities
- Reviews admissions to determine medical necessity and appropriateness of treatment.
- Reviews patient records to obtain justification of treatment.
- Secures necessary data from the clinical team for extended stay reviews.
- Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
- Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned
- Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR)
- Notify clinical teams of need for current documentation.
- Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
- Attend appropriate daily treatment team meeting
- Salary Range: $50-$57/yr