The UR Coordinator is responsible for assisting with the treatment activities offered to the patient, including the appropriate clinical screening of admissions, establishment of treatment plans, interface with the treatment team/external case managers/managed care organizations and implementation and supervision of the discharge planning.
Case Management
1. Provide for the implementation of the treatment plan and conduct an ongoing review of the plan to ensure effective implementation of all treatment interventions.
2. Maintain ongoing direct contact with the attending practitioner, treatment coordinator, and various members of the team.
3. Work with the treatment team regarding the Continuum of Care Plan and collaborate with the team when changes are needed.
4. Ensure that the patient attends the appropriate level of care or program as indicated on the treatment plan or as needed when there are changes in the patient’s status.
5. Interface with the staff of the appropriate level of care to facilitate a smooth transition at the time of transfer.
6. Maintain necessary documentation of all services and the quality of care.
7. Assure proper tracking of all reviews.
8. Maintain statistical reports and prepare documentation of significant findings.
9. Communicate and enforce the documentation requirements with all levels of staff to meet accreditation and certification body regulations.
10. Prepare the computer weekly case control sheet providing information for the intake census/planning meeting.
11. Initiate and update the denial log statistics on an ongoing basis maintaining current information at all times, and initiate appeals through telephone or written communication.
12. Promote an effective use of resources for patients, customers and the facility with sensitivity to the cost of health care.
13. Ensure that patient rights are upheld.
14. Advocate for the lowest level of care consistent with patient needs.
15. Function as a resource for patient/families/significant others.
Discharge Planning
1. Coordinate with the treatment team discharge plans to the patient/family/significant other that were identified by the treatment team.
2. Monitor the discharge planning activities.
3. Organize the use of resources to keep the patient as close to home as possible, provide liaison to aftercare providers and follow up after discharge to ensure efficacy of the discharge plans.
Treatment Planning
1. Provide support and assistance to the patient and the patient’s support system.
2. Introduce the patient to all staff members who will be coordinating their care in order to clarify treatment objectives and determine time needed in the treatment program.
3. Review assessment information with admitting practitioners and treatment coordinator and formulate AXIS IV and V diagnosis (in consultation with admitting practitioner).
4. Plan an episode of care to identify services that will be provided if the patient is moved to a greater or less intensive level of care depending on the needs of the case.
5. Communicate with attending practitioner and treatment coordinator, and other providers of service, to assure continuity of care and expedite the flow of services and transition between levels of care.
6. Provide feedback to the attending practitioner and treatment team members concerning continuing certification of days/services.
7. Communicate with external reviewers and referral sources through implementation of the R.A.P process. Conduct all needed external reviews and maintain documentation of all such interaction.
8. Ensure that third-party payors are notified of, or participate in, decisions about appropriate transitions between levels of care.
Utilization Review
1. Assist potential patients in gaining access to federal and state support systems.
2. Consult with the business office and/or admission staff as needed to clarify data and ensure the insurance pre-certification process is complete.
3. Provide clinical pre-certification information to patients, managed care companies, insurance companies and other third party reviewers to establish the length of stay or number of certified days.
4. Coordinate with the insurance company doctor in appeals process and denials process.