The Intake / Utilization Review Specialist conducts phone, walk-in, and scheduled assessment for new and return patients and follows-up and responds to all inquiries and referrals. The Intake Specialist provides emergency psychiatric consultation services to potential patients, other hospitals, referral sources, and community organizations. They work closely with physicians, referral sources, and other hospital departments to disseminate information with NSBHS and its
Responds to telephone and face-to-face inquiries from persons seeking mental health care of information about mental health related services.
Identifies needs of callers and schedules clinical assessment when necessary.
Facilitates appropriate callers' access to optimal level of care within the system.
Documents all calls and related information in intake system; ensures forms are neat and legible, gathering all possible information.
Provides back-up coverage to units if necessary.
Reviews intake paperwork for appropriate dispositions and referral sources.
Communicates parent handbook and related policies clearly to patients and families and seeks feedback to assure a clear understanding.
Assists with admission procedures, obtains patient and other required signatures on admission paperwork, obtains various releases, including patient activity participation, school records, and immunization records, physician billing, insurance, and UR companies.
Verifies all documentation on after-hours admissions ensuring completion and accuracy.
Consistently obtains re-certification of Medicaid eligibility prior to admission and requests insurance verification from business office for third party.
Establishes and maintains positive relationships with patients, physicians, allied health professionals, and all referral sources.
Conducts concurrent and extended stay reviews on assigned patients in a reasonable time frame, ensuring the information is presented in a concise, articulate manner.
Schedules upcoming reviews; notifies the attending physician of physician reviews and facilitates reviews if necessary.
Establishes a good rapport with third party reviewers while maintaining an advocacy stance on behalf of the client; submits any written materials requested by third party payers in a timely manner.
Is pro-active and independent in gathering information for reviews from the client record and takes the initiative to seek information from members of the treatment team if necessary.
Notifies all concerned parties when cases are denied, giving recommendation regarding viability of appeal; effectively coordinates collection of all pertinent data to support organization and patient's position; ensures appeals are prepared within the dictated time constraints.
Maintains accurate and current records on day's denied and current status of appeals; demonstrates effective written communication skills in formulating appeals.
Maintains appropriate records of the utilization review data and activities; updates patient accounting database daily with accurate discharge and certification information; ensures files and records are organized and thorough and easily accessible.
Participates in formulation of patient's treatment and discharge plans with other members of the treatment team.
Maintains on-going contact with insurance reviewers to maintain certification status by providing reviewing insurance with discharge information including outpatient appointments that the patient has post discharge.
Supports departmental goals by attending and participating in department meetings and offering ideas and suggestions regarding goals and objectives.