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)
SUMMARY: The primary responsibility of this position is to implement the organization’s Utilization Review(UR) process to ensure appropriate usage of available resources and to optimize reimbursement for services rendered following patient needs. The UR coordinator monitors the client population daily and regularly checks documentation for compliance with current UR best practices. The Coordinator serves as the primary liaison with payers in matters related to utilization, takes a lead role in organizing and conducting UR, and provides regular reports to facilitate decision-making by senior management. The Coordinator also assists in other key administrative functions such as handling admissions inquiries, orienting new patients and families, verification of benefits, and implementing of the organization’s performance management and improvement process.
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Desired Qualifications:
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