Utilization Review Coordinator - Phoenix, United States - Steward Health Care

Steward Health Care
Steward Health Care
Verified Company
Phoenix, United States

4 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description
***:

  • The Utilization Review staff the Utilization Review Coordinator performs administrative tasks to assist the Case.
  • Managers. Gathers and tabulates data as indicated. The Utilization Review Coordinator is responsible for writing utilization reviews and coordinating internally with Case Managers and throughout the facility for certification and recertification of insurance authorization throughout a patient's stay.
  • Assumes primary responsibility of communicating with payors to obtain authorization. Provide clinical information to payor as requested. Document authorization numbers, concurrent denial, attempts to overturn.
  • Concurrent denials and coordinate PeertoPeer communication as needed for all patient hospital stays.
  • Followup communication with payors to ensure authorization obtained for patient hospitalization.
  • Communicate appropriately with Care Manager and Social Worker regarding authorization status and payor requests.

KEY RESPONSIBILITIES:


  • Answer inquiries concerning activities and operations of department by referring to policies and procedures, as well as provide routine information as required.
  • Receive calls, disperse to Case Managers, and maintain a daily log.
  • Respond to requests for authorization for services utilizing appropriate guidelines.
  • Maintain applicable logs and databases (phone, etc.).
  • Send completed reviews to insurance companies with fax cover sheets, via computer.
  • Communicate continued stay clinical information as requested by payor or as authorization is due.
  • Communicate with Care Manager regarding status of authorization and PeertoPeer per payor requests.
  • Document authorization and concurrent denial information in Care Management documentation system daily.
  • Actively prevent denial by submitting clinical information within 24 hours of admission or as delineated by payor.
  • Assists Case Managers with denials obtains charts, gathers necessary information for Case Managers to complete reviews.
  • Document payor concurrent denial of coverage appropriately. Provide additional clinical information as required.
  • Communicate and refer to Care Manager for additional clinical or PeertoPeer discussion.
  • Document outcome of denial appeal process.
  • Compile and maintain a discharge planning directory with available Community Resources and communicate updates/changes to Case Management staff.
  • Call insurance companies for verification of authorization and complete required documentation.
  • Speaks with insurance companies and provides requested information.
  • Followup calls as needed to payors to ensure authorization is obtained for each patient.
  • Sends completed Reviews to insurance companies.
  • On occasion, may need to send medical records to physician advisor as directed by Care Manager.
  • Other duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:
(Examples: Ability to work independently and take initiative; Good judgment and problem solving skills; Communication skills; Interpersonal and organizational skills; Level of confidentiality)

  • Good organizational skills.
  • Ability to assist in development and process improvement in obtaining payor authorization and concurrent denial appeals.
  • Manages time effectively, sets priorities, and consistently meets deadlines. Excellent verbal and written communication skills.
  • Attention to detail regarding documentation and followup to ensure process completed timely.
  • Ability to effectively interact with insurance companies.
  • Effectively interact with all levels of the organization and maintain cooperative relations with internal and external customers.
  • Demonstrates initiative and proactive approach to problem resolution.
  • Performs well independently and on a team.
  • Assumes accountability for demonstrating behaviors consistent with the customer service policy.
  • Works competently with computer based charting and other clinical and nonclinical software programs.
  • Readily adapts to change.
  • Understands Medicare and Medicaid coverage details.
  • Operates office equipment efficiently.
  • Critical thinking skills required.
  • Utilizes independent judgment and discretion in the UR Coordinator role.
  • Identifies denial patterns and works with DCM and Care Management Team to positively impact outcomes.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:


  • Three to five years of experience in a behavioral health hospital setting.
  • High school diploma or GED.
  • Ability to read and communicate effectively in English required. Ability to communicate in additional languages preferred. Basic computer knowledge required, i.e. Word, Excel, Microsoft Office, Lotus Notes.
  • Fingerprint Clearance

Job Types:
Full-time, Part-time


Pay:
$ $25.35 per hour


Benefits:


  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8 hour shift

Experience:


  • Utilization review: 1 year (preferred)

License/Certification:

  • RN (preferred)
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