Utilization Review Department Coordinator

Employment Type:Full time

Shift:

Description:Under the direction of the Care Coordination Department Leadership, the UR Coordinator directs all back-office functions of the Utilization Review Department. Interfaces with all payors/providers requesting authorizations, medical records, and other specific information. Confirms completeness of reviews to payors. Directs concurrent denials to appropriate local staff.

Interfaces with all payors and providers requesting authorizations, medical records, and other specific information.

Diligently manages all clinical review work queues assigned to Utilization Management.

Coordinates Physician Advisor referrals with there are concerns regarding meeting level of care criteria (utilizing Indicia/InterQual). Reviews PA referrals with department manager as needed.

Reports an uncovered or at-risk days to leadership of Utilization Review.

Promotes teamwork by working effectively as a team member as well as independently. Communicates & collaborates with multiple team members, including Utilization Management RNs, care managers, nursing unit staff, unit secretaries, insurance representatives, & others as needed.

Ensures seamless communication with payers. Retrieves voicemails & faxes for the department & transcribes the information into the electronic medical record. Communicates in a positive, professional manner at all times.

Performs basic reception functions to ensure smooth office operations, including answering incoming calls, maintaining an accurate filing system, ensuring office supplies stocked to appropriate levels and office equipment serviced, copying forms and documents, etc.

Other duties as assigned.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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