UR Coordinator

San Antonio Behavioral Healthcare Hospital; San Antonio (TX); On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

401K

Medical/Dental insurance

Health Insurance

Vision Insurance

PTO Plan

Life Insurance

Job summary

A leading healthcare provider in San Antonio seeks a Utilization Review Coordinator to conduct patient care evaluations and monitor treatment plans. This role involves collaborating with healthcare teams to ensure quality care and compliance with insurance requirements. Candidates must hold a Bachelor's degree and have at least 1 year of experience in a related field. Knowledge of regulatory requirements and strong communication skills are essential for success. Benefits include medical coverage and retirement plans.

Qualifications

• 1 year of relatable experience required; 3 years preferred.
• Understanding of HIPAA confidentiality standards.
• Ability to effectively interact with diverse people groups.

Responsibilities

• Evaluate patient medical records to assess quality of care.
• Conduct utilization reviews to monitor healthcare resources.
• Collaborate with providers for treatment plan improvements.

Skills

Basic PC skills (Windows, Microsoft Outlook, Word, Excel)

Knowledge of governmental and managed care payer requirements

Strong diplomacy and customer service

Well-developed communication skills

Ability to work under pressure

Leadership skills

Education

Bachelor's degree

Job description

The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. They monitor patient charts and records to evaluate care concurrent with patients' treatment, review treatment plans and status of approvals from insurers, and ensure adherence to the hospital's utilization review plan. Their responsibilities also include monitoring the appropriateness of hospital admissions and extended stays, completing data collection of demographics, claim and medical information, performing non‑medical analysis, and reporting outcomes.

Essential Duties

• Evaluate patient medical records to assess the appropriateness and quality of care provided
• Verify the accuracy and completeness of documentation to support medical necessity
• Analyze treatment plans and interventions to ensure they align with patient needs and best practices
• Collaborate with healthcare providers to make recommendations for adjustments or improvements in treatment plans
• Verify insurance coverage and benefits to determine eligibility for services
• Communicate with insurance providers to obtain authorization for services as needed
• Conduct utilization reviews to monitor and optimize the use of healthcare resources
• Identify and address any utilization patterns that may indicate inefficiencies or deviations from standards of care
• Maintain accurate and detailed records of utilization review activities and outcomes
• Prepare reports and summaries of findings for internal review and compliance purposes

This job description is not intended to be all-inclusive. Employees may perform other related duties to meet the ongoing needs of the hospital. Duties may be modified or changed with or without notice.

Requirements

Education and/or Licensure: Bachelors.

Experience: 1 year of relatable experience required; 3 years preferred.

Additional Requirements: None.

Knowledge, Skills, and Abilities

• Must have basic PC skills including work on Windows OS and Microsoft Outlook, Word, and Excel.
• Knowledge of governmental and managed care payer requirements.
• Understanding of various "Self‑Pay" account classifications and their applicable patient statement processes.
• Understands the data elements required to generate a clean bill.
• Knowledge of maintaining confidentiality under HIPAA standards.
• Strong diplomacy, tact, excellent customer service, interpersonal communication, cultural sensitivity, and ability to work with diverse people groups.
• Well‑developed verbal and written communication skills in English; additional language abilities desirable.
• Knowledge of basic math and modern office procedures.
• Ability to work well under pressure with minimal supervision.
• Ability to remain seated at switchboard for long periods without significant discomfort or distress.
• Ability to effectively interact with persons of diverse roles, backgrounds, cultures, & socio‑economic classes, including those in crisis or resistant to the organization.

Physical Requirements / Environmental Conditions

• Ability to work competently with computer‑based charting and other clinical and non‑clinical software programs.
• Adaptability to change and good organizational skills; effective reading and communication in English.
• Can be expected to give presentations as directed; working knowledge of Medicare, Medicaid, HMO, and private insurance coverage details.
• Ability to advocate for patients and operate office equipment.
• Critical thinking skills.
• Leadership skills including mentoring, coaching, counseling, time management, problem solving, and strategic planning.
• Initiative and proactive problem‑resolution approach.
• Ability to effectively interact with insurance companies and community healthcare resources.
• Ability to work in a stressful, fast‑paced environment.
• The work is predominantly indoors; general temperature changes may occur but not substantial adverse conditions.

Benefits

• 401K, Medical/Dental insurance, FMLA, and Short‑Term Disability
• Health Insurance
• Vision Insurance
• Dental Insurance
• 401K Retirement Plan
• Healthcare Spending Account
• Dependent Care Spending Account
• PTO Plan with Holiday Premium Pay
• Life Insurance (Supplemental Life, Term, and Universal plans available)
• Short and Long‑Term Disability with additional buy‑in opportunities