One of the nation’s largest and most respected hospital management companies, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance. Steadily growing since its inception to an esteemed Fortune 500 corporation, UHS today has annual revenues of $10 billion and 83,000 employees. In 2018, UHS was recognized for the eighth consecutive year as one of the World’s Most Admired Companies by Fortune; and in 2017, ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.
The UHS Acute Care Division Patient Admission Review Center, supports hospitals in making patient status determination and proper documentation of the patient’s clinical presentation and diagnosis. Reviews the clinical data presented by the hospital and applies evidence based clinical decision support tools to identify options for level of care determinations and corresponding documentation standards. Advises hospitals on applicable patient status criteria and documentation practices that would substantiate the status determination, with clinical decision-making and patient status determinations remaining at all times with the treating providers and hospital at which the patient is located. Collaborates with the treating physician to ensure the patient is placed in the most appropriate status based on the clinical indications documented in the medical record.
Essential Job Duties:
Performs independent, criteria based, documentation assessment, via medical record review and discussion with the physician as needed, on all patients referred.
Applies clinical criteria and guidelines to advise on appropriateness of admission based on the use of relevant evidence based clinical decision support tools and Medicare regulations and guidelines as appropriate.
Accurately correlates clinical based data to hospital approved criteria set.
Applies best practice and standards in the Utilization Review Entry (URE) application of Midas, and as needed within the electronic medical record that supports the appropriate level of care.
Collaborates with the physician when documentation presented does not meet evidenced based medical necessity guidelines to substantiate the patient‘s level of care status selection.
Works directly with the physician advisor to obtain recommendations on cases that require additional information to ensure level of care assigned is clinically appropriate.
Documents interactions and outcomes with physician advisors in the appropriate area in Midas.
Acts as a resource to the Emergency Department physicians for any issues related to appropriate status assignment of patients.
Maintains up to date knowledge regarding changes within the evidence based clinical decision support tool.
Participates in Quality Reviews and Inter Rater Reliability processes and achieves performance results at or above thresholds established by management.
