Utilization Review Coordinator jobs in San Antonio, TX

Job Description

Summary

The Authorization Coordinator works under direction of Social Worker or Case Manager RN.

New authorization coordinator position for West Over Hills Hospital. FT, Days, Office Based. Must have reliable transportation to get to work.

Shift start times after completion of orientation are 7 : 00am, 7 : 30am or 8 : 00am. 30minute or 1hr lunch times is the candidates choice.

After completion of orientation will be added to the weekend rotation schedule to supplement coverage of the per diem workers.

Candidates will be required two of the three major holidays of Thanksgiving, Christmas or New Years. The Candidate needs to have strong computer skills including Microsoft Office, Outlook, Excel, Word and Teams.

The candidate will need strong organization and time management skills. After completion of the 90 day probationary period, the candidate will need to be near or at the daily productivity of 125-130 actions.

The Authorization Coordinator's responsibilities include but not limited to the following actions :

• Follow up on patient accounts for when authorization for stay is required
• Fax numbers to Send clinical reviews
• Follow up on each account during the stay and on discharge for authorization - document in the electronic system
• The Authorization Coordinator escalates any potential disputes or denial of accounts to director of Case Management or designee
• Trends disputed claims by at least payor and physician (e assist in obtaining authorization for patient discharged to Skilled Facilities or other post acute care that require authorization)
• Trend by payor and service any authorization not obtained by end of day
• Trend and Track on denial prevention
• Other duties as assigned

Responsibilities

Utilization Management

The Authorization Coordinator validates patient's demographic and payer information with patient / family and notifies Patient Access immediately if any corrections are needed

Validates that all commercial / managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) of variances

The Authorization Coordinator provides Important Message follow up letter to Medicare patients per Tenet policy and under the direction of the RN Case Manager or SW Transition Management

Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the electronic Tenet Case Management system

Provides patients and families with choices of post-acute providers per Tenet policy

Responds to post-acute providers timely and completes referrals per Tenet policy

Documents and communicates all elements of the post-acute referral to the RN Case Manager or SW and the healthcare team, patient / family and post-acute providers

Completes tasks as assigned by RN or LVN Case Manager and / or SW staff

Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers

Documents all referrals and tasks in the Tenet Case Management system per Tenet policy

Education - Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options

Compliance - Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services

The Authorization Coordinator adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies

Qualifications

Education

Required : High School Graduate or equivalent

Preferred : Associates or Bachelors degree

Experience

Required : Two (2) years of experience in clerical or healthcare field.

Preferred : Acute hospital experience.

Certifications

Preferred : Paramedic, EMT or Certified Nursing Assistant

LI-NS1

If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

Responsibilities

Validates patient's demographic and payer information with patient / family, and notifies Patient Access immediately if any corrections are needed.

Validates that all commercial / managed care discharges have an authorization for status and level of care provided, and notifies Director of Case Management (DCM) of variances.

Provides Important Message follow up letter to Medicare patients per Tenet policy. and under the direction of the RN Case Manager or SW.

Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the electronic Tenet Case Management system.

Provides patients and families with choices of post-acute providers per Tenet policy. Responds to post-acute providers timely and completes referrals per Tenet policy.

Documents and communicates all elements of the post-acute referral to the RN Case Manager or SW and the healthcare team, patient / family, and post-acute providers.

Completes tasks as assigned by RN or LVN Case Manager and / or SW staff. Makes copies, sends faxes, and completes phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers.

Documents all referrals and tasks in the Tenet Case Management system per Tenet policy.

Education

Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options.

Compliance

Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services.

Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies.

Qualifications

Education :

Required : High school diploma or equivalent

Preferred : Associate or bachelor's degree

Experience :

Required : 2 years of experience in clerical or healthcare field

Preferred : Acute hospital or health plan experience

Certifications :

Preferred : Paramedic, EMT or Certified Nursing Assistant

Physical Demands :

Lift / position up to 25 lbs. Push / pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending.

Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.

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About the Team

Careers at Tenet

At Tenet Healthcare, the heart of what we do centers on caring with compassion, which ultimately creates a bond between our caregivers and patients.

Everyone contributes to these moments, whether providing care directly or supporting those who do.

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Last updated : 2024-04-23