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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00113323 |
Description Activated On: 6/5/2026 12:36:58 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. The Patient Care Coordinator is responsible for the administration, planning and coordinating the Utilization Review Program at Warren State Hospital. Work involves the review, analysis and evaluation of patient records to determine the medical necessity for hospital admissions, the appropriateness of admissions, and extended length of stay. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. Work is performed with considerable independence in a close working relationship with the chairman of the Utilization Review Committee. The employee is supervised by the director of Performance Improvement. Work is reviewed for conformation with established criteria, standards and procedures by direct observation and as set forth in the hospital's Utilization Review Plan, federal and state rules, regulations, policies and procedures. 1. Administers the Utilization Review program at Warren State Hospital by studying current state and federal rules and regulations. 2. Determines the medical necessity and appropriateness of admission. 3. Approves length of stay for the newly admitted patient to Warren State Hospital by analysis of active records. 4. Monitors length of stay of all patients by concurrent review of records to assure extended stays are reviewed on a timely basis and patients are placed in appropriate level of care. 5. Certifies extended inpatient days by reviewing all patient records to determine medical necessity for continued stay. 6. Evaluates questionable admissions or continued stays by referral to the Chair of the Utilization Review Committee. 7. Incorporates state and federal rules and regulations and hospital review monitoring by effecting change of existing policies and procedures and providing up-to-date guidance for Utilization Review Committee. 8. Participates in the hospital-wide Performance Improvement program by gathering and summarizing data for monitoring. 9. Maintains effective working relationship with those responsible for patient care, medical records, social service and other allied health professionals to assure continuity of patient care. 10. Assists chairperson of U.R. Committee at bi-monthly meetings and makes recommendations on case disposition to the committee quarterly. Provides WSH Leadership an annual summary. 11. Assists with length of stay studies by reporting compliance monthly and providing a data summary quarterly. Updates the WSH Length of Stay data every 2 years. 12. Prepares and distributes quarterly reports related to hospital's Utilization Review Program and provides supervisor with quarterly reports of activities. 13. Assesses the effect of utilization review process at Warren State Hospital by completing continued stay reviews with reports to the U. R. Committee. 14. Represents Warren State Hospital and patient interests by responding to external agencies requirements for reviews and assures confidentiality of interactions and material. 15. Provides support to teams by facilitating treatment planning reviews and feedback. 16. Review chart material and explores library for research, evaluation, participation in the completion of Performance Improvement functions. 17. Provides necessary educational offerings for WSH employees. 18. Coordinates communication for Treatment Team Coordinators. 19. Coordinates and monitors completion of documentation requirements for patient transfers within WSH. Notifies responsible staff of all internal and external patient transfers. 20. Prepares a summary and analysis of PI Data as assigned. 21. Maintains ability to respond to and assist in crisis situations when possible. 22. Conducts administrative investigations, as needed. 23. Reviews and researches significant patient billing claims to ensure accuracy of service provision. 24. Participates in Human Resource interview panels and hiring process as needed. 25. Completes daily inputting of stat medication information into the OMHSAS database and reports events that exceed stat medication threshold to the respective physician for review. 26. Provides education to new employees concerning PI Department function and chart documentation requirements as part of new employee orientation. 27. Serves as a facilitator for Community Support plan meetings. 28. Provides support and back-up for infection control, as needed, including new employee physicals and annual influenza vaccination process. 29. Assists the QARM director with triennial survey preparation and maintains updated files of documentation to as required for survey. 30 Reviews, analyzes and reports on EHR documentation as it relates to patient care management. Documents UR related information within the EHR. 31. Facilitates monthly Treatment Team management Committee meeting, including collating data from monthly audits for review. 32. Completes other related duties as assigned. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. Work is approved by Supervisor and completed independently based upon a predetermined schedule for reviews in order to validate utilization review team certifications Decisions are completed independently based upon a predetermined schedule for reviews in order to validate utilization review team certifications based upon employee's training. job knowledge and competency. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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