Utilization Review Coordinator jobs in Erie, 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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RN Peer Review Coordinator
  • Allegheny Health Network
  • Erie, PA FULL_TIME
  • Company :

    Allegheny Health Network

    Job Description :

    GENERAL OVERVIEW:

    The Peer Review Coordinator will support the hospital's medical staff peer review function in compliance with legal and regulatory standards, CMS Conditions of Participation and the Medical Staff Bylaws. The Peer Review Coordinator will oversee the day to day peer review process including acceptance of cases for peer review, facilitating first level screening if applicable, preparation of case review documents, documentation of peer review results, production of reports and maintenance of the peer review records. This person will remain current and insure compliance with peer review state statues, federal requirements, medical staff bylaws, internal policies and procedures, and Joint Commission regulations. They will be responsible for the education of the peer review process to hospital leadership, medical staff, and quality staff as appropriate. This position will support the medical staff and medical committees with a focus on peer review such as MSQI, service line committees and the organization through use of clinical expertise in review of concerns regarding quality of clinical care. The Peer Review Specialists collaborates with the medical staff leadership including multiple hospitals Peer Review Committees, The Medical Executive Committee (MEC), and the Medical Research, Education and Affairs Committee.

    This person will collaborate with members of the Risk Management, Patient Safety and Quality, Information Technologies, Clinical Resource Management and others as needed to obtain information related to performance of peer duties and responsibilities. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Allegheny Health Network.

    ESSENTIAL RESPONSIBILITIES:

    • Oversees the day to day peer review process from acceptance of cases for peer review, facilitating first level screening if applicable, preparation of case review documents, documentation of peer review results, production of reports and maintenance of the peer review records. (20%)
    • Ensures compliance to all standards and regulations involving medical staff peer review. Also, ensures compliance with the peer review process as outlined in the Medical Staff Bylaws and regulatory requirements. Proactively reviews professional sources for changes in the peer review process, regulatory changes, and legal. Responds to external audits triggered by quality incidence or performance issues. (20%)
    • Secures all documents utilizing legal peer review protection. Maintains systems and processes of review (Paper, Electronic) per applicable regulations and laws for confidentiality and record maintenance. (15%)
    • Develops a mechanism to distribute peer review findings and actions throughout the organization while preserving confidentiality. Cultivates a supportive and accountable warning / escalation system regarding peer review. (15%)
    • Schedules and prepares for meetings as appropriate (Room reservations, agenda management, minutes, food, equipment, etc). Collaborates with physician leadership regarding peer review for hospital level meetings ie: Medical Staff Quality Improvement (MSQI), Department Peer Review Meetings; Orthopaedic (Ortho), Obstetric/Gynecologic (Ob/Gyn), Pediatric (Peds), Trauma Transportable Physician Orders for Patient Preference/Peer Review (Trauma TPOPP/Peer Review) , Surgery, etc. Incorporates information from RL Solutions reports, adverse events, and other sources into the peer review process. (20%)
    • Ensures confidentiality with patient and physician information, PHI, and demonstrates understanding of HIPAA. (5%)
    • Answers the phones and responds to customer needs professionally. Participates willingly in department meetings to enhance team work and efficiency within the department. Willingly takes on additional assignments as needed within the department. (5%)

    QUALIFICATIONS:

    QUALIFICATIONS:

    Minimum

    • 3-5 years of previous clinical experience
    • Registered Nurse (RN)

    Preferred

    • Bachelor’s Degree in Healthcare or Business
    • 3-5 years of previous quality improvement or patient safety experience

    SKILLS:

    • Ability to define problems, collect data, establish facts, and draw valid conclusions
    • Ability to use word processing, spreadsheet, power point presentation, and third party vendor specific software (Midas, RL Solutions, etc)
    • Advanced knowledge of healthcare regulations, accreditation guidelines and standards related to the peer review process
    • Positive and highly effective interpersonal and written and verbal communication skills
    • Ability to work effectively with various levels of management personnel, physicians, board members, and other community members
    • Advanced skills in leadership and facilitation, decision-making, change management and conflict resolution
    • Excellent Time Management And Organizational Skills
    • Excellent analytical, critical thinking, and problem-solving skills
    • Ability to manage multiple priority projects simultaneously
    • Able to work flexible hours as needed
    • Able to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions
    • Demonstrates ability to maintain information in a confidential manner

    Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

    Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


    As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

    Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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    For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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  • 1 Month Ago

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RN Peer Review Coordinator (Full Time), St. Vincent
  • Allegheny Health Network
  • Erie, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : St. Vincent Hospital St. Vincent Hospital is a Magnet®-designated hospital for excellence in nursing, serving the people in the Lake Erie region si...
  • 1 Month Ago

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Paid Product Tester
  • Product Review Jobs
  • Cranesville, PA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 1 Day Ago

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Paid Product Tester
  • Product Review Jobs
  • Hydetown, PA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 1 Day Ago

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Paid Product Tester
  • Product Review Jobs
  • Mills, PA FULL_TIME
  • Compensation: Varies per assignment. Up to $500 per week.Location: Remote (USA)Company: ProductReviewJobsThank you for your interest in becoming a Paid Product Tester. This opportunity is for completi...
  • 1 Day Ago

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Medical Review Office Assistant (Certified Medical Assistant) - Occupational Health Office - Erie
  • Allegheny Health Network
  • Erie, PA FULL_TIME
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW : Works directly under a licensed physician that is a Medical Review Officer to organize and facilitate the drug testing process. ...
  • 11 Days Ago

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0 Utilization Review Coordinator jobs found in Erie, PA area

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Private Duty Nurse LPN
  • Aveanna Healthcare
  • Erie, PA
  • Are you looking for a change of pace? Trying to find a new job outside of the nursing home or hospital? Aveanna Healthca...
  • 3/29/2024 12:00:00 AM

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Shift Supervisor (Full-Time)
  • AutoZone, Inc.
  • Erie, PA
  • AutoZone's Full-Time Shift Supervisors assist the Store Manager with leading company initiatives and ensuring maximum pr...
  • 3/29/2024 12:00:00 AM

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Reservation Associate (Remote)
  • Feyer&Associates
  • Erie, PA
  • We are seeking detail-oriented and dedicated Reservation Associates to join our team. As a Reservation Associate, you wi...
  • 3/28/2024 12:00:00 AM

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Network Administrator
  • Syntricate Technologies Inc
  • Erie, PA
  • Network Administrator Location: Erie, PA Fulltime Daily operational hands-on network duties working with Layer 1-7 switc...
  • 3/28/2024 12:00:00 AM

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RN - 7North Med Surg (Casual), St. Vincent
  • Highmark Health
  • Erie, PA
  • Company : Allegheny Health Network Job Description : 7North Med Surg 7North Med Surg Unit has 13 beds is Urology/Bariatr...
  • 3/27/2024 12:00:00 AM

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Child Care Assistant Group Supervisor
  • Highmark Health
  • Erie, PA
  • Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Assist in the daily functions the classroom as di...
  • 3/27/2024 12:00:00 AM

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Technical Manager I
  • Franklin Energy
  • Erie, PA
  • COMPANY Summary As a combined organization, Franklin Energy and AM Conservation Group is undertaking what is perhaps the...
  • 3/26/2024 12:00:00 AM

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Executive Chef
  • Hospitality Company/Industry
  • Erie, PA
  • Job Description Job Description Executive Chef A private and prestigious Club in Erie, Pennsylvania established in 1893 ...
  • 3/25/2024 12:00:00 AM

Erie (/ˈɪəri/; EER-ee) is a city on the south shore of Lake Erie and the county seat of Erie County, Pennsylvania, United States. Named for the lake and the Native American Erie people who lived in the area until the mid-17th century, Erie is the fourth-largest city in Pennsylvania, as well as the largest city in Northwestern Pennsylvania, with a population of 101,786 at the 2010 census. The estimated population in 2017 had decreased to 97,369. The Erie metropolitan area, equivalent to all of Erie County, consists of 276,207 residents. The Erie-Meadville, PA Combined Statistical Area has a pop...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$74,515 to $92,298
Erie, 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