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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00250453 |
Description Activated On: 1/6/2026 3:17:42 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. NSH is an inpatient psychiatric hospital serving civil and forensic populations 18 years of age or older at the Norristown site. Employee holds the position of Patient Care Coordinator with the Utilization Review (UR) Program. The work involves reviewing, analyzing, and evaluating patient records to determine the medical necessity for hospital admissions and the appropriateness of admissions and extended stays. |
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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. 1) Ensures timely monitoring of admissions and continued stays within the Electronic Health Record (EHR) to assure appropriateness of continued inpatient hospitalization through clinical documentation. 2) Conducts quality reviews of active patient records for documentation from all treatment team members for frequency of documentation and quality of content. 3) Reviews work for conformance with established criteria, standards and procedures set forth in the hospital's UR Plan, Federal and State rules, regulations, policies and procedures, and Medicare regulations. 4) Assigns appropriate lengths of stay to those admissions determined to be medically necessary and appropriate. 5) Certifies additional length of stay periods when determined to be medically appropriate and necessary. 6) Prepares and distributes EHR review feedback to appropriate departments and monitors follow through. 7) Refers difficult or questionable admissions or extended stays to the UR Advisor. 8) Chairs/Co-Chairs Utilization Review Committee meetings and provides supportive data, making recommendations on case disposition. 9) Coordinates Managed Medicare precertification reviews; performs concurrent reviews per insurer’s requirements to request continued stay approvals for billing. 10) Coordinates documentation from physician, MD, and SW for Medicaid applications. 11) Prepares required reports for Performance Improvement (PI) Council and UR Committee. 12) Serves as the main contact for private insurance reviews for patients. 13) Makes daily contact for updates when patients are admitted to outside hospitals. 14) Manages patient cases for continuity of care. 15) Serves as co-coordinator of patient-to-patient abuse/ROSA investigations and as backup for patient abuse investigations when needed. In this capacity employee: a. Presents ROSA data to the subcommittee to ensure accuracy and completeness and that all necessary steps have been taken to close the investigation. b. Reviews reports to ensure timeliness, completeness, and adherence to required components. c. Completes required notifications to Adult Protective Services and related outside agencies when needed. 16) Assists in the preparation of required reports which includes tracking the completion of delineated follow-ups. 17) Implements Performance Improvement techniques including PDCA methodology in the performance of assigned tasks. 18) Assists in the ongoing preparation for surveys by third party surveyors including CMS, DOH, DRP, etc. 19) Implements Performance Improvement principles and techniques and participates in PI teams and/or task groups as needed, utilizing the PDCA methodology; develops audits as necessary for presentation to committees and appropriate administrative sources. 20) Provides training to staff as required in the areas of Utilization Review and ROSA issues. 21) Serves as backup for training new employees at New Hire Orientation. 22) Assists in the development/updating of policies and new trainings: Crisis Management and Physical Holds, Abuse Recognition and Reporting, Treatment Planning, and others as designated. 23) Provides supervision in the form of review of compliance with the above, corrective suggestions, and consultation to team members as needed. 24) In conjunction with medical records, enters Financial Eligibility and insurance information for admissions, step-downs, and changes as informed by the Financial Reimbursement Office, Pharmacy, and/or EHR administration. 25) Performs other related tasks/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. Employee independently assigns lengths of stay for all inpatients and makes decisions regarding completeness of rape or sexual abuse (ROSA) investigations. Decisions regarding appropriateness of admissions and continued stay of patients are referred to the physician advisor of the UR program. |
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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. N/A 5. N/A 6. N/A |
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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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