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Utilization Review Coordinator - West Pines

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Unit Description


Care Site Description
West Pines Behavioral Health is part of SCL Health System, a faith-based, nonprofit health care organization.
 
Interested in making a difference? Then check us out. Our rich heritage and mission, and our focus on health care delivery that values person-centered care, excellence and accountability are a winning combination as we bring health – and hope – to our patients.
 
Fast Facts
  • Wheat Ridge, Colo. (estab. 1988)
  • On the campus of Lutheran Medical Center

Services & Expertise

  • Serves adults 18 & older with psychiatric or substance abuse concerns
  • Integrated treatment for those affected by both chemical dependency & an emotional or psychiatric disorder 
  • Outpatient programs, partial hospitalization, residential substance abuse treatment & inpatient acute care
  • Holistic treatment approach focuses on the patient’s physical, emotional, social & spiritual well-being
  • Providing hope, healing & recovery for patients & their loved ones
Visit: www.westpinesrecovery.org



Description

Review requests for authorization and monitor care during authorized periods of stay for levels of care. Reviews patients' medical charts to ascertain the medical necessity for services and the appropriateness of level of care.
  • Conduct on-site review of medical records at clinical facilities according to organization standards.
  • Maintain frequent telephone contact with clinical service providers to perform defined duties and facilitate communication between the organization and the provider.
  • Document UR/case management activities such as precertifications, concurrent and retrospective reviews.
  • Consult regularly with other organization staff to review treatment plans when level of clinical care requires further clarification.
  • Maintain a tracking system and clear, concise records for monitoring and reviewing cases.
  • Prepare documentation/case synopsis upon closure of cases as required by clients.
  • Provide phone crisis intervention services and precertification evaluations for inpatient hospitalization and other levels of care.
  • Provide consultation and training to providers regarding authorization procedures and utilization review for a specific course or nature of treatment.
  • Contribute to policy review and procedure development and evaluation.
  • Performs other duties as assigned, some of which may be essential to the job.

·         The information above is for summary purposes, and is not intended to be a comprehensive list of essential functions.       


Qualifications

Prefer previous experience in Utilization Review process

 

Organization: West Pines, Wheat Ridge, CO
Primary Location: CO-Denver/Boulder/Surrounding Areas-Wheat Ridge
Department: EWP-Administration
Schedule: Part-time
Shift: Day Shift
Job Posting: 4/12/2017 11:02:14 PM
FTE: .6
Job Number: 17001819
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