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Position Title : Utilization Review Coordinator
Department : Administrative
Reports To : Executive / Program Director
Supervises : NA
Entry Level Qualifications :
A current RN, LPC, LMFT, LMSW, or LCSW license preferred. Two years minimum experience in utilization review preferred. Must possess good grammatical and communication skills.
Must be skilled in Microsoft Office applications and have a working knowledge of office equipment.
1.Must be able to read and comprehend hand-written, printed, and on-line treatment notes and plans.
2.Must be able to hear and comprehend conversations and instructions.
3.Must be able to continuously sit for approximately 7 hrs. per 8 hr. shift.
4.Must be able to walk within the facility a total of approximately two (2) hrs. per day.
5.If recovering, two years of continuous verifiable abstinence.
General Responsibilities :
Complete coordination of the facilities insurance certification including precertification and continued stay reviews, as well as follow up on all insurance denials, appeals and reconsiderations.
Know and abide by the general provisions of 42 CFR Part 2, Confidentiality of Drug and Alcohol Abuse Patient Records , and 45 CFR Health Insurance Portability and Accountability Act.
This position has unrestricted access to patient identifying and patient health information.
Essential Functions :
1.Perform all pre admission certification reviews, continued stay reviews, appeals, denials and / or reconsiderations and provide
information to the appropriate review agency or insurance company.
2.Maintain an "UR Activity Log" which records every review for the facility with financial classification and U.R. information / activity.
3.Maintain a "call back' calendar for continued stay reviews and maintain a U.R. file for each patient.
requested, the status of the request, outcome and information about the next review.
5.Review and maintain all correspondence pertaining to certification, appeals, denials or reconsiderations, and ensure they are
scanned into the patient electronic health record.
6.Complete all Quality Improvement indicators for Utilization Management, data analysis and reporting.
7.Educate counseling staff regarding data needed to adequately document patient care and educate crisis staff regarding data
needed to adequately document intake assessments and managed care criteria.
8.Ability to work in a constant state of alertness as to perform the job safely.
9.Ability to work in cooperative manner with co-workers, managers, clients and prospective managers.
10.Regular attendance.
11.Any other duties as assigned by supervisor.
Last updated : 2024-05-01
Full Time
Ambulatory Healthcare Services
$71k-88k (estimate)
05/02/2024
05/15/2024
bradfordhealth.com
NASHVILLE, TN
500 - 1,000
1977
Private
CONNIE WOODS
$10M - $50M
Ambulatory Healthcare Services
Bradford is a healthcare organization that offers evidence-based drug and alcohol rehabilitation services for patients.
The job skills required for Utilization review coordinator include Patient Care, Accountability, Quality Improvement, Confidentiality, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization review coordinator. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization review coordinator. Select any job title you are interested in and start to search job requirements.
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