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Utilization Mgmt Reviewer - Princeton Center for Eating Disorder (PCED) (Plainsboro, NJ)
Job ID :92285
Job Category: Behavioral Health/Psychology
Specialty Area: Behavioral Health/Psychology
Primary Shift: Day
Work Schedule: This is a full-time day opportunity.
Penn Medicine Entity: Penn Medicine Princeton Health
Location: Plainsboro, NJ
Address: 1 Plainsboro Road
Education Required: Per Position Description
Experience Required: 5 - 7 Years
Employment Type: Full-Time Regular
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?Position Description :Penn Medicine Princeton Health is searching for a full-time Utilization Management Reviewer for our Princeton House - Princeton Center for Eating Disorder (PCED) in Plainsboro, NJ.Position Summary:Conducts Utilization Management reviews for Princeton House Princeton Center for Eating Disorder (PCED) patients, assigned by the Department Director. Documents in the facility-wide computer system the results of each review, conducted both internally and externally (with managed care organizations). Familiarity with Princeton House services/programs in all locations is essential.Some job functions and duties will include, but are not limited to: Perform admission review for assigned patients to determine the medical necessity and appropriateness of admission based on departmental policy and procedure Maintain system for monitoring admissions to assure the review of extended stay and communication of such information to insurance providers/managed care companies in a timely fashion. Maintains a schedule of additional review dates for patients requiring concurrent review. This information is to be maintained in the SQL Database as per department policies and procedures. Conducts Utilization Management reviews for assigned patients, regardless of their insurance, to determine need for treatment and appropriateness of care. Discusses concerns regarding these issues with the attending physician and, if necessary, the treatment team and proactively works to resolve UM issues Collect and record all information necessary for admission and extended stay review. Attend staffing or treatment team meetings as needed to provide information as needed to payers to support medical necessity. For those patients in treatment with the involvement of a managed care company, conducts concurrent reviews with managed care companies, in order to obtain certification for treatment designated as medically necessary by the treatment staff for that patient.Minimum Requirements :Education Masters level degree in healthcare field, or significant combination of credentials and experience for the job (i.e., RN, LPN, BSW, etc.) maintaining clinical competence in specific area of expertise.Related Work Experience Experience in psychiatric care and/or addictions treatment, with a minimum of five (5) years’ clinical experience.Licensure, Certification or Registration Requirements: Masters level degree in healthcare field, or significant combination of credentials and experience for the job (i.e., RN, LPN, BSW, etc.) maintaining clinical competence in specific area of expertise.Specialized Skills & Knowledge Requirements: Ability to read and comprehend basic instructions, correspondence, memos and similar business materials. Ability to write business-related correspondence, including appeal letters. Ability to interact with healthcare professionals in all disciplines in order to assemble and communicate a clear, concise understanding of the patient’s healthcare needs. Adequate typing skills are essential, typing a minimum of 35 words per minute. Organizational, quantitative and analytical skill relevant to creating and/or reading reports and identifying trends. Ability to multi-task, including applying problem-solving skills to situations involving multiple variables that arise in the inpatient setting. Familiarity with health insurance, managed care organizations, third party payors, and level of care criteria. Possession of strong clinical skills and knowledge of behavioral health resource management and ability to prepare clinical reviews to managed care companies and insure appropriate and necessary utilization of Princeton House internal resources. Ability to develop good working relationships with managed care organizations, and to provide excellent customer service. Must be able to be proactive, demonstrate strong negotiation skills, and patient/institution advocacy skills. Ability to develop good working relationships with managed care organizations, and provide excellent customer service. Must be able to be proactive, demonstrate strong negotiation skills, and patient/institution advocacy skills. Professional composure is required in all interactions with managed care organizations under all circumstances. Adequate typing skills are necessary, typing minimally 35 words per minute. A strong attention to detail is required, so as to minimize any misunderstandings regarding services, which are certified, and strong communication skills to impart this information to the treatment team, Administration, and Billing Services. Ability to multitask and work in a fast paced environment with constant interruptions.Additional Information :We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.Penn Medicine http://www.pennmedicine.org/careers/Live Your Life's WorkEOE/AA, Minority/Female/Disabled/VeteranWe are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.
