How to Apply
A cover letter is required for consideration for this position and should be attached as the first page of your resume. The cover letter should address your specific interest in the position and outline skills and experience that directly relate to this position.
This key individual will handle all insurance/payer contacts for the Department of Psychiatry’s Hospital Services Section. Areas include an adult inpatient unit, child & adolescent inpatient unit, consult-liaison services, partial psychiatric hospital and an Electroconvulsive Therapy (ECT) unit. The ideal candidate will have a clinical background and work with the Faculty, Admissions Coordinators, Social Work staff and outside facilities to ensure timely insurance authorizations are obtained. This role will be responsible for completing pre-authorizations for transitions of care, direct admissions and procedures, as well as inpatient continued stay reviews. The Specialist will monitor the comprehensive care plan for each patient and combine clinical and quality considerations with regulatory and financial Utilization Review (UR) demands. The Specialist will communicate approvals, denials, and assist in revenue cycle appeals.
This role requires an understanding of insurance review processes and excellent communication skills to facilitate efficient interactions with nursing, physicians, social workers and the business office.
- Coordinate and conduct admission, concurrent and discharge reviews. Initiate interventions with appropriate teams when criteria are not met for admission or continued stay. Handle need for retrospective payer chart reviews related to changes with insurance status, etc.
- Demonstrate insurance knowledge of payer guidelines to determine authorization requirements. Demonstrate understanding of medical and psychiatric terminology to assist faculty and staff with accurately identifying level of care and possible denial issues.
- Utilize payer specific UR review protocols and document and track all payer contacts, authorizations, and outcomes to assure appropriate payment of claims for authorized services.
- Communicate payers’ concerns to physicians and/or other members of the team regarding authorization status and insurance requirements when necessary. Maintain complete and accurate documentation of reviews and payer contacts according to departmental standards. Exercise knowledge to select and include necessary clinical information when providing such information to third party reviewers and care managers.
- Complete the authorization/certification screens in MCCM (Utilization Review software) and MiChart for all patient encounters and coverages. Determine downstream errors in patient data existing in MCCM and initiate corrections in MiChart as needed.
- Attend and participate in departmental meeting and daily interdisciplinary team meetings. Incorporate knowledge gained into operational activities as appropriate.
- Provide physicians and/or social workers feedback regarding utilization and discharge planning issues, including documentation requirements, level of care assessments, denial and delays affecting patient ability to reach targeted discharge timeline.
- Collaborate with the psychiatric teams to improve utilization outcomes. Educate the psychiatric teams regarding payer utilization review and authorization requirements.
- Assist in developing educational/training materials to expedite understanding and productive workflow. Foster training and development skills for new UR staff.
- Participate in the overall professional achievements of UMHS and the Department of Psychiatry, positively represent both in all duties and interactions to achieve quality, operational and financial goal and objectives.
- 2-year degree program, at minimum.
- Experience in healthcare setting.
- Strong interpersonal communication and negotiation skills including problem solving and decision making are required.
- Strong multitasking, organization, written and verbal communication skills are required.
- Must have demonstrated ability to work well with physicians and other health providers.
- Strong dedication to customer service and the ability to work within a team-focused, participative management framework is required.
- Demonstrated computer competency and ability to communicate via telephone is required.
- LPN, BSW, RN, Health Information technician with at least 2-3 years of utilization review experience.
- Current State of Michigan licensure or Current National board certification.
- Two (2)-3 years of clinical experience in a psychiatric setting.
- Knowledge of Psychiatric Inpatient Facility and Procedural (i.e. Electroconvulsive Therapy) criteria, Behavior Health payer criterion including BH InterQual criterion set, appeal processes, third party and government regulations is preferred.
- Prefer some experience with University of Michigan Hospital and Health Systems computer applications that are necessary to complete the assigned computer related duties.
Monday - Friday
University Hospital South
This is a non-union position.
Under Michigan law, a criminal history check including fingerprinting is required as a condition of transfer or employment for this position.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.