American Addiction Centers UR Coordinator in Las Vegas, Nevada
Job Summary: SOLUTIONS RECOVERY
The UR Coordinator is responsible for case management and communicating census data to teams which in turn drives the level of care received by the clients. The UR Coordinator will carry a case load and ensure the client’s are covered at the appropriate level of care.
Complies with all performance measuring regarding precertification, concurrent reviews and appeals.
Maintains an accurate record of authorizations in company designated platforms in a timely manner.
Reviews all clinical documentation necessary for insurance authorization review.
Collects, reviews and analyzes utilization review information and participate in special utilization review projects.
Works cooperatively with clinical team members to obtain necessary clinical information.
Attends UR Meetings in person or via remote connection to discuss activities/needs of UR department.
Update UR census data with new admissions and level of care (LOC). Send daily census data to clinical team and upload to Share Point for billing team. Follow-up with UR team on missing authorizations and new admits.
Update monthly dashboard with key metrics, such as, number of clients, LOC, billed days, and uncovered days.
Track each client’s LOC changes on a data sheet and submit to Facility CEO monthly.
Monthly, create a random list of charts from Accucare. Distribute to UR team in order to complete a quality assessment.
As needed, answer overflow calls from reception area and forward to the appropriate department/person.
Pre-certify insurance clients by completing reviews as needed with insurance companies to extend the stay of client in treatment; work with the clinical and client care team to communicate insurance case managers request for specific treatment, follow ups, and individualized care; communicate authorizations to clinical team; and prepare for weekly meetings to discuss appropriate discharge dates based on authorizations.
Other job duties – as assigned
EDUCATION, EXPERIENCE SKILLS & ABILITIES
Required – Bachelor’s Prepared RN with unrestricted nursing license in the state of facility location and 2 years of UR; Substance abuse or behavioral health field preferred OR
Master’s prepared, licensed in a behavioral health or social work field with 2 years of UR experience; Substance abuse or behavioral health field preferred
Experience with EMR; Aura EMR preferred
Experience with ASAM criteria preferred
Excellent verbal and written communication skills
Ability to speak clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; and participates in meetings.
Excellent organizational and time management skills
MicrosoftOffice systems proficiency
If in personal recovery, a minimum of 2 years clean and sober
AAC is committed to principles of equal opportunities for all employees. The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.
Job ID: 2018-2202
External Company Name: American Addiction Centers
External Company URL: http://contactaac.com
Street: 2975 S Rainbow Blvd