Position summary

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.

Requirements

The specific duties of the Utilization Review Coordinator include but are not limited to:

  1. 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.
  2. Managing and performing the processes for retrospective authorizations and denials/appeals.
  3. 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.

More Requirements

  1. Documenting activity in Billing and UR software, and preparing reports for meetings and management review.
  2. Organizing and filing documents for ease of access in approved locations.
  3. Assisting in compiling information for data analysis relating to preauthorization and reimbursement.
  4. Providing assistance to hospital staff in determining the likelihood of insurances covering treatment.
  5. Maintaining patient confidentiality in accordance with state and federal law.
  6. Participating in hospital information meetings, required in-service education and training, and hospital-wide performance improvement and compliance activities.
  7. Promote and incorporate service excellence standards into job responsibilities and interactions. This includes incorporating service recovery skills into difficult patient discussions, and respecting the rights of patients and staff not to participate in or listen to conversations where frustrations and grievances are expressed in an unproductive manner.

Other Skills, Abilities and Requirements

  1. Extensive knowledge of behavioral health systems and Utilization Management required.
  2. Two years of UR experience in a hospital or healthcare insurance setting required.
  3. MSW, BSN, RN, CDP, or LICSW license in good standing preferred.