Utilization Review Coordinator jobs in Lincoln, NE

This in office position is a quality based, detail-oriented position is located in Lincoln, Nebraska or Tulsa, Oklahoma.

Office Hours: Monday through Friday from 8:30am to 5pm

AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care. With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality, and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience.

AIS Healthcare offers great benefits, including health, vision and dental insurance, long term disability insurance, life insurance, a vacation package, and a 401K plan with a generous employer match.

JOB SUMMARY:

• This position is responsible for coordinating all aspects of the patient care program by working collaboratively with the ANS Nursing team, Home Connect Coordinator team, internal operational teams, referral sources, and patients to provide seamless care through quality and coordination of patient care. The role collaborates with the treatment teams to coordinate documentation requirements and deliverables. 
• The position is responsible for reviewing, sending, and tracking nursing documentation to the provider and provider signed nursing orders are received in a timely manner. This position is also responsible for compiling documentation for medical records requests, periodic quality audits, data mining, initiating, and supporting processes for the team. This is an in-office position.

EDUCATION AND EXPERIENCE:

• Preferred: Medical assistant, Patient Care Coordinator, or Customer Service related position in Home Health, Ambulatory Care, or Hospital setting with at least one year of experience in a medical setting strongly preferred.
• Associated degree required, bachelor’s degree in healthcare administration preferred.
• Understanding of managed care organizations or insurance preferred.
• Medical terminology experience preferred.
• Proficient computer skills in the use of Microsoft applications and Electronic Medical Records.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Recognizes patients’ rights and responsibilities and supports them in the performance of job duties; respects patient’s rights to privacy and confidentiality.
• Works collaboratively with nurse leadership, supervisor, and field nurses to ensure the database is maintained and processes are followed.
• Reviews and audits patient medical charts for accuracy, audits, monitors and ensures completion of documentation.
• Tracks and monitors provider compliance with signing and returning all needed patient discharge documentation, verbal orders, and plan of care.
• Maintains patient records in compliance with HIPAA, state and ACHC/URAC regulations.
• Generate medical records for legal and compliance team when requested.
• Responsible for management and timely response to internal and external customer emails, voicemails, and fax communications.
• Complies with all applicable company policies and procedures
• Performs other job-related duties as assigned.
• May also cross train to perform duties related to processing patient home refill referrals which include:

1. Performs the intake of patient referrals.
2. Manages patient flow from referral to nursing intervention.
3. Responsible for system data entry and ensuring accuracy, including, but not limited to patient demographics, documentation, validity of orders and quality audits.
4. Reviews elements of the orders to ensure all information needed for scheduling, compounding and delivery are stated, if information is missing contacts the appropriate person in order to retrieve the information or get a new order.
5. Provides support to field nursing team and management.
6. Thoroughly reviews, notifies the prescriber, nurse, and leadership of changes in the condition and/or needs of the patient and documents.

QUALIFICATION REQUIREMENTS:

• Independent judgement and discretion.
• Problem solving expertise.
• Demonstrate extreme attention to detail and accuracy.
• Excellent interpersonal skills.
• Ability to work in a team environment, while also delivering independent results.

Steps to Apply:

To apply for this role, you must complete a Culture Index Assessment to be considered. Please note that your application will not be considered if the Assessment is not completed.

Copy and paste the following link into your browser and press enter. Then, select the corresponding position for which you are applying. (Only one assessment per candidate is required.) The assessment is brief, taking less than ten minutes to complete.

portal.cultureindex.com/public/survey/general/0BFB8F0000