The Utilization Review Coordinator is responsible for ensuring that financial benefits are maximized in the treatment and discharge planning for assigned cases through initial and continued stay reviews, prior authorization work for discharge services, effective liaison work and communication between business office and treatment team, support of the discharge plan, and active pursuit of appeals. Additionally, the Utilization Review Coordinator:
Conducts concurrent and extended stay reviews on assigned patients in a reasonable time frame, ensuring the information is presented in a concise, articulate manner.
Schedules upcoming reviews; notifies the attending physician of physician reviews and facilitates reviews if necessary.
Establishes a good rapport with third party reviewers while maintaining an advocacy stance on behalf of the client; submits any written materials requested by third party payers in a timely manner.
Is pro-active and independent in gathering information for reviews from the client record and takes the initiative to seek information from members of the treatment team if necessary.
Notifies all concerned parties when cases are denied, giving recommendation regarding viability of appeal; effectively coordinates collection of all pertinent data to support organization and patientâ€™s position; ensures appeals are prepared within the dictated time constraints.
Maintains accurate and current records on dayâ€™s denied and current status of appeals; demonstrates effective written communication skills in formulating appeals.
Maintains appropriate records of the utilization review data and activities; updates patient accounting database daily with accurate discharge and certification information; ensures files and records are organized and thorough and easily accessible.
Participates in formulation of patientâ€™s treatment and discharge plans with other members of the treatment team.
Maintains on-going contact with insurance reviewers to maintain certification status by providing reviewing insurance with discharge information including outpatient appointments that the patient has post discharge.
Supports departmental goals by attending and participating in department meetings and offering ideas and suggestions regarding goals and objectives.