Strategic Utilization & Discharge Coordinator

Oceans Healthcare, L.L.C.; West Chester (Chester County); On-site; USD 60,000 - 80,000; Full time

Job summary

Oceans Healthcare, L.L.C. is seeking an experienced Utilization Review Coordinator to manage the facility's inpatient, partial hospitalization, and outpatient utilization review activities.

You will conduct concurrent reviews, coordinate with third-party payers and medical staff, and ensure accurate documentation of admission criteria, discharge planning, and authorization status. The role requires attention to regulatory standards and teamwork.

Responsibilities

• Identifies and reports appropriate use, under-use, over-use and inefficient use of services to ensure high quality patient care.
• Reviews inpatient, partial hospitalization, and outpatient records to determine appropriateness and clinical necessity of admissions, continued stay, and discharge.
• Coordinates flow of communication between physicians, staff and third party payers concerning reimbursement requisites.
• Attends mini-treatment team and morning status meetings to obtain third-party payer pre-certification and ongoing certification requirements.
• Maintains abstract with updates provided to third party payers; notifies physicians of reimbursement issues.
• Initiates and completes appeals process for reimbursement denials; notifies inpatients of denials received.
• Reports monthly all Hospital Issued Notices of Non-coverage (HINN) to QIO; ensures all authorization and denied information is in the system at end of day.

Job description

Oceans Healthcare, L.L.C. is seeking an experienced Utilization Review Coordinator to manage the facility's inpatient, partial hospitalization, and outpatient utilization review activities.

You will conduct concurrent reviews, coordinate with third-party payers and medical staff, and ensure accurate documentation of admission criteria, discharge planning, and authorization status. The role requires attention to regulatory standards and teamwork.