Utilization Review Coordinator jobs in Allentown, PA

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Coordinator (REMOTE)
  • Pyramid Healthcare
  • Allentown, PA FULL_TIME
  • With this position you would have the ability to work from home!!

    Shift: Monday-Friday 8:00 am - 4:30 pm

    Deliverables/Principal Results Expected:

    • Perform admission, continued stay and discharge reviews on all managed care clients.

    • Maintain positive relationships with referral sources and insurance companies.

    • Track admissions, continued stay and discharge PCPC requirements for county referrals.

    • Maintain organized system of reporting to counselors when PCPC’s are due and when review calls are to be made.

    • Maintain current insurance eligibility information through EVS, Navinet, etc.

    • Monitor Census for accuracy of funding.

    • Attend clinical staffing to obtain information for client reviews.

    • Maintain daily UR database accurately.

    • Perform Act 106 reviews and follow up appeals.

    • Track all county referrals for documentation of admission calls.

    • Maintain and participate in chart reviews to ensure proper paperwork is in place.

    • Work directly with Billing Department to reduce uncovered days of funding. Investigate cases with insurance and referral sources to recuperate lost days of funding.

    • Report to the Assessment Manager on a weekly basis.

    • Manage all self-pay clients and clients with copays, deductibles, coinsurance and liabilities.

    • Reduce client balances.

    • Other duties as assigned.

     

    Technical Competencies:

    Provide the company with accurate information to ensure full financial coverage for each client day. Provide the referral source(s) with timely information to ensure good customer focus. Maintain client confidentiality and provide a safe therapeutic treatment. Knowledge of local, state and federal regulations. Knowledge of facility contracts and agreements. Knowledge of medical terminology, appeal and denial process, composition of medical records. Knowledge of data entry (primarily Excel) and mathematics. Knowledge of pre-certification process and PCPC. Knowledge of CARF standards, release of information and confidentiality. Knowledge of DSM IV, private care managers and county referral sources.

    Total Rewards:

    • Medical, Dental, and Vision Insurance
    • Flexible Spending Accounts
    • Life Insurance
    • Paid Time Off
    • 401(k) with Company Match
    • Tuition Reimbursement
    • Employee Recognition Programs
    • Referral Bonus opportunities
    • And More!

    Pyramid CORE Values:

    We are committed and proud to live our CORE values and use them to inspire those around us. Our employees are expected to align with these values, behaviors and standards. We are held accountable for upholding these CORE Values: INTEGRITY is striving to be honest, transparent and ethical when dealing with clients, staff and the community. DEDICATION is demonstrating an unwavering commitment to always provide exceptional care and support to those we serve is needed daily. COLLABORATION is a steadfast, team-focused approach; working together to achieve excellence. PASSION is genuine, compelling and relentless desire to improve lives and support Pyramid Healthcare’s mission.

    Want to know more?

    To learn more about Pyramid Healthcare, and how you can achieve personal and professional growth, visit us at: https://bit.ly/Pyramid-Careers.

    Pyramid Healthcare, Inc. is proud of its diverse workforce, and is an Equal Opportunity Employer.

  • 15 Days Ago

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Utilization Review Nurse
  • St. Lukes Hospital
  • Bethlehem, PA PART_TIME
  • St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisf...
  • 13 Days Ago

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Utilization Management Specialist
  • Medix
  • Bethlehem, PA FULL_TIME
  • Medix is currently hiring for an Utilization Management Specialist for a Hosptial system in Bethlehem, PA. This position is fully onsite at the hospital. The UM Specialist will assist Utilization Mana...
  • 22 Days Ago

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Quality Record Review Specialist 1st Shift
  • QuVa Pharma Inc.
  • Bloomsbury, NJ FULL_TIME
  • Our Quality Record Review Specialist plays a vital role in ensuring the highest quality and safety standards of our pharmaceutical products. Once you complete our training, your responsibilities will ...
  • 1 Day Ago

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Engineered Wood Products Technical Plan Review/EWP Designer
  • Eastern Engineered Wood Products
  • Bethlehem, PA FULL_TIME
  • Summary This position is responsible for analyzing and evaluating floor and roof EWP placement layouts completed by peers. After review conclusion, reviewers have the responsibility to provide accurat...
  • 2 Days Ago

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Engineered Wood Products Technical Plan Review/EWP Designer
  • Eastern Engineered Wood Products
  • Bethlehem, PA FULL_TIME
  • Summary This position is responsible for analyzing and evaluating floor and roof EWP placement layouts completed by peers. After review conclusion, reviewers have the responsibility to provide accurat...
  • 2 Days Ago

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0 Utilization Review Coordinator jobs found in Allentown, PA area

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Front Desk Coordinator, Full Time - Emmaus, PA
  • St. Lukes Health Network
  • Emmaus, PA
  • Front Desk Coordinator, Full Time - Emmaus, PA page is loaded **Front Desk Coordinator, Full Time - Emmaus, PA** **Front...
  • 3/28/2024 12:00:00 AM

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Front Desk Coordinator, Float, Part Time- Miners Region
  • St. Lukes Health Network
  • Bethlehem, PA
  • ***St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our mo...
  • 3/28/2024 12:00:00 AM

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Front Desk Coordinator- Full time, St. Luke's North, Bethlehem PA
  • St. Lukes Health Network
  • Bethlehem, PA
  • Front Desk Coordinator- Full time, St. Luke's North, Bethlehem PA page is loaded **Front Desk Coordinator- Full time, St...
  • 3/28/2024 12:00:00 AM

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Front Desk Coordinator, Float - All Regions
  • St. Lukes Health Network
  • Bethlehem, PA
  • Front Desk Coordinator, Float - All Regions page is loaded **Front Desk Coordinator, Float - All Regions** **Front Desk ...
  • 3/28/2024 12:00:00 AM

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Front Desk Coordinator, Full Time - Bethlehem, PA - Sign-On Bonus Available!
  • St. Lukes Health Network
  • Bethlehem, PA
  • Front Desk Coordinator, Full Time - Bethlehem, PA - Sign-On Bonus Available! page is loaded **Front Desk Coordinator, Fu...
  • 3/28/2024 12:00:00 AM

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Recovery Specialist - Substance Use Disorders
  • St Luke's University Health Network
  • Sellersville, PA
  • St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most ...
  • 3/28/2024 12:00:00 AM

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Cash Office Associate
  • Weis
  • Easton, PA
  • Overview Looking for a company that treats associates with respect, understanding, and appreciation? Looking for a compa...
  • 3/25/2024 12:00:00 AM

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Patient Engagement Partner, Oncology/Palliative Access Center - Remote position (PA/NJ residency)
  • St. Luke's University Health Network
  • Allentown, PA
  • St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most ...
  • 3/24/2024 12:00:00 AM

Allentown (Pennsylvania Dutch: Allenschteddel) is a city located in Lehigh County, Pennsylvania, United States. It is Pennsylvania's third most populous city and the 231st largest city in the United States. As of the 2010 census, the city had a total population of 118,032 and is currently the fastest growing city in all of Pennsylvania. It is the largest city in the metropolitan area known as the Lehigh Valley, which had a population of 821,623 residents as of 2010[update]. Allentown constitutes a portion of the New York City Combined Statistical Area and is the county seat of Lehigh County. ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$81,299 to $100,701
Allentown, Pennsylvania area prices
were up 1.5% from a year ago

Utilization Review Coordinator in Fort Lauderdale, FL
Some review coordinator positions require that professionals have training and experience within a more specific field.
January 10, 2020
Utilization Review Coordinator in Asheville, NC
Schick Shadel Hospital is seeking a part-time (20 hours per week) Utilization Review Coordinator (UR Coordinator) to help oversee and perform the process of utilization review to ensure appropriate reimbursement by third party payers.
January 04, 2020
Utilization Review Coordinator in Jacksonville, FL
Excellent benefits, pay, small on-site employee gym, wonderful co-workers and managersFull Review.
January 04, 2020