UR Coordinator

Job ID
2018-1159
# of Openings
1
US-FL-Riverview
Posted Date
2 weeks ago(1/8/2018 6:01 PM)
Category
Clinical

Overview

Job Summary:

 

The UR Coordinator is responsible for case management and communicating census data to teams which in turn drives the level of care received by the clients. The UR Coordinator will carry a case load and ensure the client’s are covered at the appropriate level of care.

 

Report To: Utilization Review Manager

Status PRN

Responsibilities

Job Duties:

  • Complies with all performance measuring regarding precertification, concurrent reviews and appeals.
  • Maintains an accurate record of authorizations in company designated platforms in a timely manner.
  • Reviews all clinical documentation necessary for insurance authorization review.
  • Collects, reviews and analyzes utilization review information and participate in special utilization review projects.
  • Works cooperatively with clinical team members to obtain necessary clinical information.
  • Attends UR Meetings in person or via remote connection to discuss activities/needs of UR department.
  • Update UR census data with new admissions and level of care (LOC). Send daily census data to clinical team and upload to Share Point for billing team. Follow-up with UR team on missing authorizations and new admits.
  • Update monthly dashboard with key metrics, such as, number of clients, LOC, billed days, and uncovered days.
  • Track each client’s LOC changes on a data sheet and submit to Facility CEO monthly.
  • Monthly, create a random list of charts from Accucare. Distribute to UR team in order to complete a quality assessment.
  • As needed, answer overflow calls from reception area and forward to the appropriate department/person.
  • Pre-certify insurance clients by completing reviews as needed with insurance companies to extend the stay of client in treatment; work with the clinical and client care team to communicate insurance case managers request for specific treatment, follow ups, and individualized care; communicate authorizations to clinical team; and prepare for weekly meetings to discuss appropriate discharge dates based on authorizations.
  • Other job duties – as assigned

Qualifications

Job Responsibilities:

  • Master's Degree in a behavioral health related field or RN (Registered Nurse),  credentials preferred.
    • Master’s Degree in a behavioral health related field and 2+ years experience in behavioral health and/or utilization management services. 
    • OR
    • Bachelor’s degree in a behavioral health related field 4+ years experience in behavioral health and/or utilization management services.
  • Two year’s medical billing experience.
  • Ability to read and interpret written information; write clearly and informatively; edits work for spelling and grammar.
  • Ability to speak clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; and participates in meetings.
  • Working knowledge of Microsoft Word, Excel, and Outlook.
  • Candidates in recovery must have 2+ years of sobriety.

AAC is committed to principles of equal opportunities for all employees.  The Company will provide reasonable accommodations that are necessary to comply with State and Federal disability discrimination laws.

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