Acute Care Utilization Coordinator

Highland Hospital; Charleston (WV); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Comprehensive benefits

Competitive salary

EOE

Job summary

Highland Hospital in Charleston, West Virginia is seeking a Utilization Assistant - Acute to support utilization review activities and coordinate insurance coverage for patients. You will work with admissions, medical records, and payers to verify benefits and ensure timely approvals.

Responsibilities include pre-certifications, post-admission verification, and collaboration with the business office. A High School Diploma is required; a Bachelor's in social work or mental health is preferred,

Qualifications

• Supports utilization review activities to improve collection, reimbursement, coordination, and presentation of information.
• Verifies benefits timely with managed care organizations.
• Pre-certifications and post-admission benefit verification.
• Responds to inquiries from patients, families, and professional referral sources.

Responsibilities

• Assists admissions with pre-certifications of care.
• Reviews medical records for appropriateness of level of care at admission and at intervals.
• Conducts reviews with payers to ensure certification of care.
• Maintains accurate documentation for utilization management.
• Coordinates information with business office to resolve payment problems.
• Attends daily treatment team meetings to discuss patient insurance status.
• Ensures benefits are verified in a timely manner.
• Reports UR or Quality issues to supervisor for timely resolution.
• Responds to telephone and Internet inquiries.
• Researches insurance guidelines for admission and continuing stay criteria.

Skills

Communication

Clinical experience

Inquiry handling

Education

High School Diploma

Bachelor's Degree in social work or mental health

Job description

Highland Hospital in Charleston, West Virginia is seeking a Utilization Assistant - Acute to support utilization review activities and coordinate insurance coverage for patients. You will work with admissions, medical records, and payers to verify benefits and ensure timely approvals.

Responsibilities include pre-certifications, post-admission verification, and collaboration with the business office. A High School Diploma is required; a Bachelor's in social work or mental health is preferred,