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)
Description
CTS Health Services is a community mental health services center that specializes in a holistic approach to health and wellness for children, parents, and adults of varying circumstances and mental challenges. We provide one-on-one behavioral interventions for our clients and their support circles to help our clients navigate through life within their community at their highest level.
The Utilization Review Coordinator's primary function is utilization management, conducting utilization review of initial authorizations and concurrent authorizations for new and existing persons referred, requesting, or actively receiving services. This position also reviews authorizations for all Levels of Care (LOCs) and services. The Utilization/Risk Management department will also conduct perspective, concurrent, and retrospective reviews for authorization of LOCs/services for individuals, conducts reviews using clinical information submitted by Program Managers, direct contact with staff and insurance companies, review of medical necessity records, and contact with the individual and family members when needed. Another function of the Utilization/Risk Management department is also to review and process all billing (including EOB) claims and payroll functions for CTS Health, Inc. in coordination with the agency’s finance team. Staff members must maintain reports/trackers that are supplied to their supervisors or other Executive Team Members as requested.
** This role is temporary role with a possibility of converting to permanent at a later time.
Responsibilities of Utilization Review Coordinator, not limited to:
Requirements
Requirements of the Utilization Review Coordinator
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