Utilization Review Coordinator Jobs

About The Position

Requirements

• Bachelor’s degree in Behavioral Health, Social Work, Counseling, Nursing, or Psychology.
• At least 2 years of utilization review experience in a hospital setting.
• At least 2 years of case management experience, including discharge planning, in a hospital setting.
• Strong knowledge of medications.
• Exceptional time-management, data-entry, and communication skills.
• Detail-oriented.

Nice To Haves

• Master’s degree.
• Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification.

Responsibilities

• File documents as needed.
• Complete initial precertification with payors.
• Conduct concurrent clinical reviews with payors.
• Document in the electronic system daily and in real time.
• Perform admission audits.
• Ensure providers complete CON’s/RON’s and CMS certifications.
• Demonstrate professionalism with internal and external customers and communicate effectively with staff and patients to establish and maintain productive working relationships.
• Maintain knowledge of current trends and developments in the field by reading relevant literature and attending seminars or conferences.
• Protect the privacy of health information disclosed in written, electronic, or oral form.
• Maintain good rapport and cooperate with nursing staff, medical staff, and other departments.
• Seek guidance and comply with applicable federal and state laws and hospital policies.
• Comply with hospital expectations for ethical behavior and standards of conduct, and with federal and hospital requirements regarding protected health information and patient information.
• Handle reconsiderations, assist with appeals as needed, arrange peer-to-peer reviews, and report outcomes to the VP of Care Management and Team.
• Educate nursing staff, leadership, and providers regarding documentation.
• Work with the business office to resolve appeals and denials and conduct retrospective reviews.

Benefits

• Competitive pay rates.
• Medical, dental, and vision insurance.
• NPH 401(k) plan with up to 4% company match.
• Employee Assistance Program (EAP) programs.
• Generous PTO and time-off policy.
• Special tuition offers through Capella University.
• Work/life balance and professional growth opportunities.
• Employee discounts through LifeMart.