What are the responsibilities and job description for the Utilization Review Coordinator position at Prime Healthcare?
Overview
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities
The Utilization Review Coordinator (URC) essentially functions as a Subject Matter Expert (SME) with regards to coordinating the UR and appeals process as part of the denial management initiatives for all payors. This position will function along with the Medical Review Coordinators (MRCs) responsible for clinical processes and the UR techs responsible for all clerical processes within the front-end UR and denial management processes. The URC is responsible for ensuring the accounts will be processed in a timely and accurate manner for both authorization follow-up and appeals, thereby contributing to appropriate data tracking maneuvers. The URC will also participate in creating and implementing appropriate training material and agenda for new employees. This position will develop metrics and provide an analytical approach to help interpret and implement solutions inferred from trends observed from the available data. Additionally, this position entails working closely with the Corporate/Facility/Remote UR/CM teams, Business Office, Case Managers, Physicians and Administration. The URC will serve as the representative of the UR team with respect to all clerical functions including but not limited to the authorization follow up, documentation, and denial management for Traditional Medicare/ Medicaid as well as Managed care/ commercial payors. With an understanding of the scope of services for the department, the URC will assist the department leadership in accomplishing the set goals for the UR team. Other duties as assigned.
Qualifications
Required Qualifications:
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $30.00 to $40.50. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
Responsibilities
The Utilization Review Coordinator (URC) essentially functions as a Subject Matter Expert (SME) with regards to coordinating the UR and appeals process as part of the denial management initiatives for all payors. This position will function along with the Medical Review Coordinators (MRCs) responsible for clinical processes and the UR techs responsible for all clerical processes within the front-end UR and denial management processes. The URC is responsible for ensuring the accounts will be processed in a timely and accurate manner for both authorization follow-up and appeals, thereby contributing to appropriate data tracking maneuvers. The URC will also participate in creating and implementing appropriate training material and agenda for new employees. This position will develop metrics and provide an analytical approach to help interpret and implement solutions inferred from trends observed from the available data. Additionally, this position entails working closely with the Corporate/Facility/Remote UR/CM teams, Business Office, Case Managers, Physicians and Administration. The URC will serve as the representative of the UR team with respect to all clerical functions including but not limited to the authorization follow up, documentation, and denial management for Traditional Medicare/ Medicaid as well as Managed care/ commercial payors. With an understanding of the scope of services for the department, the URC will assist the department leadership in accomplishing the set goals for the UR team. Other duties as assigned.
Qualifications
Required Qualifications:
- Bachelor’s degree in Healthcare related field (including Health Information Management and Pharmacy)
- Microsoft Office proficiency.
- Strong communication skills.
- Completion of a medical terminology course.
- Knowledge of HIPAA regulations.
- Excellent written and verbal communication skills. Excellent critical thinking skills.
- Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
- Ability to work independently in a time-oriented environment.
- Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.
Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $30.00 to $40.50. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
Salary : $30 - $41