Utilization Review Coordinator

Job description

Description Job Summary: The UR Coordinator’s primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for all provided services. The UR Coordinator will function as liaison between payor source(s), the finance office, and the clinical treatment team, providing information and feedback to assist in optimum patient care and reimbursement. Duties/Responsibilities: - Review of patient admission data and clinical documentation to ensure compliance with insurance and governmental regulations relating to medical necessity and case documentation. - Collect and compile data needed for prior authorization, concurrent review, discharge notifications and retrospective reviews. - Ensure all authorization requests have been completed for inpatient and outpatient services, according to applicable facility and insurance policies. - Maintains detailed and complete documentation regarding the UR process for each case. - Actively communicate with interdisciplinary team regarding patient diagnosis, utilization of services, length of treatment, authorization status and case documentation. - Participation with departmen...