Utilization Review Coordinator
Location: Everwell Port St. Lucie Hospital, Inc
Position Summary
Everwell Port St. Lucie Hospital is seeking a detail-oriented Utilization Review Coordinator to coordinate insurance reviews, monitor patient authorizations, and support effective communication between the hospital, physicians, and insurance providers.
Key Responsibilities
Review all patients’ admissions on a daily basis to determine necessity and appropriateness of placement services as outlined in Plans and Procedures.
Assigns continued stay reviews according to criteria; reviews continued stay at least every ten (10) to fourteen (14) days and certified pursuant to approved criteria.
Maintains a system for monitoring all admissions to assure timely reviews; collects and records all necessary information/data for review of admission, continued stay, and utilization of services.
Reviews patient records upon request of insurance companies and communicates patient condition and treatment to external utilization review offices.
Contacts physicians and primary Nurses for clarification of information as necessary.
Assures appropriate Authorization of Release of Information forms are obtained prior to releasing information to insurance companies.
Completes mental health treatment reports and other reports, including appeal letters, required by insurance companies for review of patient care and treatment as requested.
Monitors information that is copied and sent per request to insurance companies for inpatient and assures that only required information is disseminated.
Contacts physicians, primary Nurses and other appropriate staff regarding potential problems or questions related to documentation of patient care issues.
Coordinates and schedules all PRO reconsideration hearings and schedules appropriate staff to attend hearings.
Coordinates the assemblage of records for review by Federal State, Professional and appropriate hospital groups.
Performs special projects or other related work as required or requested.
Shows ability to communicate in a clear and concise manner.
Demonstrates ability to work with others.
Adapt to changing situations or work assignments.
Demonstrates willingness to rotate to other areas of hospital within the limits of preparation and skill level.
Conform to uniform and dress code, personal hygiene and good grooming.
Wear and properly display name badge.
Positively respond to guidance or counseling and attempts to benefit by it.
Adept in identifying potential problems within the department and seeks management guidance.
Demonstrates excellent organizational skills and originator of new ideas and methods.
Use verbal and non-verbal communication with others, i.e., courtesy, tone of voice, facial expressions, gestures, etc.
Demonstrates an understanding of and adherence to the Code of Conduct
Conduct reflects Oglethorpe’s values and a commitment to the Code of Conduct
Qualifications and Education
RN, LPN or Master's Level Clinician with experience
CPR Certification required
Minimum 2 years of healthcare experience preferred
Knowledge of utilization review processes and medical terminology
Experience working with insurance companies and behavioral health
documentation preferred
Ability to use data collection techniques, and statistical computations.
Strong communication, organizational, and analytical skills
Familiarity with DSM criteria and healthcare compliance standards preferred
Thorough knowledge of effective and appropriate charting principles
Work Environment
Primarily indoor, temperature-controlled healthcare environment
Collaborative team-focused setting
Benefits
Medical, Dental and Vision insurance
401K
PTO and Sick time
This position requires a pre-employment Level 2 Background check: https://info.flclearinghouse.com
Utilization Review Coordinator • Port St. Lucie, Florida
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