Utilization Review Coordinator

JOB SUMMARY

We are seeking a skilled Utilization Review Coordinator (URC) to oversee patient insurance certification, compliance with governmental regulations related to hospital stays, and the prevention of denials. Embedded within our utilization review management platform are clinical criteria guidelines, streamlining the review and documentation process. The Utilization/Risk Management department conducts perspective, concurrent, and retrospective reviews for authorization of Levels of Care (LOCs) and services, engaging with Program Managers, reviewing medical necessity records, and liaising with individuals and their families when necessary. Additionally, the department handles billing and payroll functions.

PRIMARY RESPONSIBILITIES

• Evaluate patient records to assess severity of illness and intensity of service.
• Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of s...