Utilization Review Coordinator jobs in Portsmouth, NH

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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Registered Nurse - Utilization Review Coordinator
  • Exeter Hospital
  • Exeter, NH PER_DIEM
  • Hybrid opportunity, must be local to Exeter, NH. 

    Exeter Hospital, Core Physicians, and Rockingham VNA & Hospice, part of Beth Israel Lahey Health, proudly serve the beautiful NH seacoast region. Our principal mission is to work together to create healthier communities. What makes us unique is the spirit of our staff who are team-oriented and focused on providing an outstanding patient care experience and quality outcomes for those we are privileged to serve. In addition, we want to ensure that our employees feel well cared for by offering a comprehensive benefits package, on-going training and growth opportunities, wellness resources, special perks, and more.

    Our Magnet designation is recognition of our excellent nursing staff and the high quality, innovative patient care we deliver every day in our community.

    Provides coordination of benefits and related services to specific patient groups to assure the highest quality of care is provided in a cost-effective manner. Works with insurers the PRO for Medicare and Medicaid billing physicians and a variety of other decision-makers for medical appropriateness.

    Requirements:

    • 1-3 years experience
    • RN license - NH or other Compact State
    • Utilization Management Certified within 1 year of hire

    Major Responsibilities:

    1. Reviews all admissions and provides clinical information to third party payors as required by contracts.
    2. Maintains a working knowledge of nationally accepted criteria sets (Milliman and Interqual) for inpatient vs outpatient status.
    3. Attends complex discharge rounds on Wednesday when scheduled.
    4. Links Utilization Management with Case Management .
    5. Reviews notices of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters.
    6. Tracks denial information for reporting to Quarterly UR Committee.
    7. Provides ongoing education to the medical; nursing and hospital staff on current utilization practices and documentation requirements.
    8. Collaborates with Pre-cert and Patient Accounts staff as needed to ensure proper payment.

    Learn more about Nursing at Exeter here: Nursing at Exeter

  • 25 Days Ago

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Utilization Review Specialist
  • PMC Medical Group
  • Somersworth, NH FULL_TIME
  • PMC Medical Group, a well-established independently owned multi-disciplinary practice, is seeking a full-time Utilization Review Specialist. Summary: Provide comprehensive assessment, planning, implem...
  • 22 Days Ago

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Registered Nurse - Utilization Management Coordinator
  • Exeter Hospital
  • Exeter, NH PER_DIEM
  • Exeter Hospital, Core Physicians, and Rockingham VNA & Hospice, part of Beth Israel Lahey Health, proudly serve the beautiful NH seacoast region. Our principal mission is to work together to create he...
  • 27 Days Ago

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Tester
  • Product Review Jobs
  • Newfields, NH FULL_TIME
  • Compensation : Varies per assignment. Up to $500 per week. Location : Remote (USA) Company : ProductReviewJobs Thank you for your interest in becoming a Paid Product Tester. This opportunity is for co...
  • 19 Days Ago

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Scheduling coordinator
  • Advanced Surgical Associates
  • Kittery, ME FULL_TIME
  • We are an elite oral surgery practice that is committed to exceptional care for our patients and first-class service to our referring doctors. We are looking for a fun, hardworking, compassionate, tea...
  • 19 Days Ago

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Intake Coordinator
  • Local Infusion
  • Portsmouth, NH FULL_TIME
  • Job Description Job Description We are Local Infusion. Local Infusion is a venture-backed healthcare company shaping the way care is delivered to patients with chronic autoimmune disease on specialty ...
  • 19 Days Ago

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0 Utilization Review Coordinator jobs found in Portsmouth, NH area

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Health Unit Coord- Per Diem- Center for Pain Management
  • Partners Healthcare System
  • Dover, NH
  • Wentworth-Douglass Hospital, a subsidiary of Massachusetts General Hospital, is renowned as one of the largest acute car...
  • 3/28/2024 12:00:00 AM

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Coordinator, Claims Administrative Services (Remote Available)
  • Lincoln Financial
  • Dover, NH
  • Alternate Locations: Charlotte, NC (North Carolina); Dover, NH (New Hampshire); Omaha, NE (Nebraska); Work from Home Wor...
  • 3/28/2024 12:00:00 AM

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Elliot Health System - UR RN Supervisor - Care Coordinator - Full Time
  • Elliot Health
  • Manchester, NH
  • Come work at the best place to give and receive care! Job Description: Who We Are: The Care Coordination Department at t...
  • 3/28/2024 12:00:00 AM

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Operations Support Supervisor
  • Gatso Usa Inc
  • Beverly, MA
  • Job Description Job Description About Sensys Gatso Sensys Gatso USA, part of the Sensys Gatso Group in Sweden, is celebr...
  • 3/28/2024 12:00:00 AM

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Health Unit Coordinator Critical Care Unit (ICU) Per Diem
  • Partners Healthcare System
  • Dover, NH
  • Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, te...
  • 3/27/2024 12:00:00 AM

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Farm Office Manager
  • Brick Ends Farm
  • South Hamilton, MA
  • Job Description Job Description Job Title: Dispatcher/Office Manager Our company is a family business that has been Turi...
  • 3/27/2024 12:00:00 AM

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Switchboard Operator Part Time
  • Wentworth-Douglass Hospital(WDH)
  • Dover, NH
  • Wentworth-Douglass Hospital, an affiliate of Mass General Brigham, is committed to supporting patient care, research, te...
  • 3/26/2024 12:00:00 AM

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Administrative Assistant
  • CAI
  • Concord, NH
  • Administrative Assistant Req number: R2126 Employment type: Full time Worksite flexibility: Onsite Job Summary As the Ad...
  • 3/15/2024 12:00:00 AM

Portsmouth is a city in Rockingham County, New Hampshire, United States. As of the 2010 census it had a population of 21,233, and in 2017 the estimated population was 21,796. A historic seaport and popular summer tourist destination on the Piscataqua River bordering the state of Maine, Portsmouth was formerly the home of the Strategic Air Command's Pease Air Force Base, since converted to Portsmouth International Airport at Pease. According to the United States Census Bureau, the city has a total area of 16.8 square miles (43.6 km2), of which 15.6 square miles (40.5 km2) is land and 1.2 square...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$83,171 to $103,019
Portsmouth, New Hampshire area prices
were up 1.4% 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