Utilization Review Coordinator in Nevada

Responsible for ensuring that all initial authorizations are initiated with appropriate payor, required notes are documented, and the authorization detail is set up in Case Management. The information is subsequently verified in the payor websites where applicable. Review Daily Discharges to ensure that all days are authorized and identify denied days, coordinate with Director of Utilization Review and add to Denial Tracker when appropriate. Monitor and update file for accounts without discharge diagnosis.

KEY RESPONSIBILITIES:

Initial Authorizations

Runs the morning report and identifies all accounts where an authorization doesn’t exist and enters appropriate data in the appropriate field to identify the department responsible for obtaining initial authorization. Confirms the level of care matches in AIS with the patient diagnosis and the insurance authorizations.  

Daily...