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.
We reveal and foster God's healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.
Inspired by our faith,
•We will be distinguished as the premier person-centered health system and trusted partner.
•We will share accountability with clinicians and other stakeholders to coordinate care across all settin...gs and improve access, quality, health outcomes, and affordability.
•We will grow as community-based health networks to serve more people in partnerships with others who share our vision and values.
Caring Spirit - We honor the sacred dignity of each person.
Excellence - We set and surpass high standards.
Good Humor - We create joyful and welcoming environments.
Integrity - We do the right thing with openness and pride.
Safety - We deliver care that seeks to eliminate all harm for patients and associates.
Stewardship - We are accountable for the resources entrusted to us.