Utilization Review Coordinator

The 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 patients’ treatment. Reviews treatment plans and status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. Monitors the appropriateness of hospital admissions and extended hospitals stays. Completing data collection of demographics, claim and medical information; non-medical analysis; and outcomes reporting. May consult with staff as needed.

Requirements

Job Requirements

Education and/or Licensure – High School degree or equivalent required, Bachelor’s degree preferred.

Experience – 3-5 years Admitting or Financial Counseling preferred.

Additional Requirements – None.

Knowledge Skills and Abilities

·         Proven ability to problem-solve, perform critical thinking.

·         Requires good listening, interpersonal and communication skills, and professional, pleasant, and respectful telephone etiquette.

·         Ability to maintain a professional demeanor in a highly stressful and emotional environment, to include crime, behavioral health and suffering patients in addition to life-or-death situations.

·         Must be able to exhibit a high level of empathy with the ability to effectively communicate with patients and family members during traumatic events, while demonstrating exceptional customer service skills.

·         Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.

·         Excellent data entry, numeric, typing and computer navigational skills.

·         Basic computer skills and Microsoft Office and Excel.

·         Has knowledge of governmental and managed care payer requirements.

·         Demonstrates understanding of the various "Self-Pay" account classifications and their applicable patient statement processes.

·         Understands the data elements required to generate a clean bill.

·         Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards.

·         Knowledge of basic math and modern office procedures.

Physical Requirements/Environmental Conditions

Perform the following with or without reasonable accommodations:

·         Ability to stoop, kneel, crouch, crawl, reach, stand, walk, push, pull, lift, grasp, and be able to perceive the attributes of objects such as size, shape, temperature, and/or texture by touching with skin, particularly that of the fingertips. 

·         Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly.

·         Hearing to perceive the nature of sound with no less than 40 db loss @ Hz, 1000 Hz, and 2000 Hz with or without correction; ability to perceive detailed information orally and make fine discriminations in sound. 

·         Perform repetitive motions with wrists, hands, and fingers. Individual must be able to exert up to 100 pounds of force occasionally and to be able to lift, carry, push, pull, or otherwise move objects. 

·         Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks, as well as inspect and analyze.

·         Must be able to work and concentrate amidst distractions such as noise, conversation and foot traffic; ability to handle interruptions often and be able to move from one task to another

·         While worker may possibly be subjected to temperature changes, the worker is generally not substantially exposed to adverse environmental conditions as the work is predominantly inside.

Benefits

• Health Insurance
• Vision Insurance
• Dental Insurance
• 401K Retirement Plan
• Healthcare Spending Account
• Dependent Care Spending Account
• PTO Plan with Holiday Premium Pay
• Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
• Short and Long-Term Disability (with additional buy-in opportunities)