Schick Shadel Hospital is seeking a part-time (20 hours per week) Utilization Review Coordinator (UR Coordinator) to help oversee and perform the process of utilization review to ensure appropriate reimbursement by third party payers. This includes managing the denial/appeals process, as well as the flow, organization, and reporting of information.
The specific duties of the Utilization Review Coordinator include but are not limited to:
- Obtaining preauthorization for admissions and continued stays according to third party guidelines within one business day of admission (unless otherwise required), including researching and obtaining any necessary insurance contact information, and coordinating scheduled meetings between hospital and insurance doctors.
- Managing and performing the processes for retrospective authorizations and denials/appeals.
- Timely communicating preauthorization outcomes, follow-up instructions, options, and related information to relevant hospital staff and patients. This includes responding to all calls and emails within one business day unless otherwise required.