Utilization Review Coordinator
Employment Type : Full-Time
Coordinates utilization functions and personnel to comply with hospital procedures and federal regulations. Acts as an internal resource for questions regarding patient care. Ensures that RCA facility staff is caring for patients appropriately. May require a bachelor's degree or equivalent experience in field or related area. Familiar with standard concepts, practices, and procedure. Performs a variety of tasks. Typically reports to a supervisor or manager. Specific Responsibilities:
- Works on UR team and assists other members and managers
- Provides information at the request of other members of the U/R team.
- Consistently works to assist with the development of new and innovative systems to help maximize patient days.
- Provide reliable trending analysis of current and past data related to length of stay and days authorized by specific insurance companies.
- Experience working with in-network and out-of-network benefits to help maximize patient days.
- Work closely with Medical team, Clinical team, and Primary Therapists.
- Some knowledge of all continuums of care, including admission assessment and continued stay criteria.
- Ensure quality and quantity of documentation in medical records for UR.
- This job description is not designed to cover or contain comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Education and Experience:
- Associates Degree, Bachelor's degree preferred
- 3+ years' experience in substance abuse or related field
- Excellent organizational skills with the ability to prioritize workload
- Proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
Competencies:
- Customer Service: Demonstrates concern for meeting internal external customers' needs in a manner that provides satisfaction for the customer within the resources that can be made available.
- Problem Solving: Identifies problems, involves others in seeking solutions, conducts appropriate analysis, searches for best solutions; responds quickly on new challenges.
- Communication: Comfortable using a broad range of communication to different audiences in diverse solutions.
- Project Management: Coordinates the diverse components of the projects by balancing scope, time, cost, and quality.
Work Environment: May work in a variety of environments including professional offices, clinics, hospitals, or out-patient facilities. They spend much of their time on their feet, actively working with patients. Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus. Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.