Utilization Review Coordinator-Full Time

Florida Medical Center; Lauderdale Lakes (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

Florida Medical Center is seeking a Utilization Review Coordinator responsible for monitoring hospital services and ensuring adherence to utilization review plans. The role requires strong communication, organizational skills, and experience in medical settings, all aimed at achieving effective patient care and outcomes.

Benefits

Opportunities for training and advancement

Comprehensive Employee Benefits

Qualifications

• Minimum 2 years experience as a utilization coordinator in a medical or hospital setting preferred.
• Excellent oral and written communication skills.
• Ability to function independently with minimal supervision.

Responsibilities

• Monitors adherence to the hospital's utilization review plan.
• Performs concurrent reviews for patients to ensure justified extended stays.
• Coordinates department activities and maintains communication for discharge planning.

Skills

Communication

Organizational Skills

Time Management

Education

High School Diploma

Associate Degree or equivalent training

Tools

Availity

Job description

WE ARE FLORIDA MEDICAL!

Our 459-bed acute care hospital has made excellence in delivering healthcare a priority, and it shows:

• We are home to the Heart Institute of Florida, where our doctors have worked on the leading edge of cardiac care for more than 40 years.
• We are part of the Advanced Neuroscience Network, leading the way in brain and spinal care in Florida.
• We have a comprehensive stroke center that offers fast, effective stroke care for a strong recovery.

At Florida Medical Center, we are committed to delivering the highest quality care possible to each of our patients. We strive to help patients achieve better outcomes, quicker recovery times, shorter hospital stays and ultimately, better health. As a result of our efforts, Florida Medical Center has received numerous prestigious awards and accolades from trusted organizations including the Florida Agency for Health Care Administration (AHCA) and the American Heart/Stroke Association.

WHAT WE OFFER

• Essential/stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
• Hourly pay is negotiable based on experience. We offer competitive market pay and opportunities for bonus depending on great work performance
• Comprehensive Employee Benefits: Full and Part Time employees are eligible for various plans for medical, dental, and vision insurance.

POSITION SUMMARY:

The Utilization Review Coordinator will monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services and monitor the appropriateness of hospital admissions and extended hospital stays. The UR coordinator will obtain authorizations for all observation and inpatient accounts, ensure discharge summaries and notifications are faxed to appropriate payors daily. The UR coordinator will act as a resource person the utilization review RN and Prior Auth Coordinator, check multiple portals to obtain adverse determinations and maintains positives relationships with the payors

DUTIES/RESPONSIBILITIES:

• Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
• Coordinates and supervises the activities of the Utilization Review Department.
• Calculates the lengths of stay and continued-stay days for patients.
• Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or continued stay.
• Assists the Utilization Review Committee in the assessment and resolution of utilization review problems.
• Identifies problems related to the quality of patient care and refers them to the Quality Assurance Committee.
• Maintains communication with the Social Service Department to facilitate timely discharge planning.
• Compiles monthly reports and statistics for presentation to the Utilization Review Committee.

CUSTOMER SERVICE RESPONSIBILITIES:

Performs duties and conducts interpersonal relationships in a manner designed to project a positive image of the department and the hospital. Works with supervisor/manager and other members of section or department to promote a harmonious work environment. Ensures that all contacts with patients, the public, physicians and other hospital personnel are carried out in a friendly, courteous, helpful and considerate manner. Answers telephones in a prompt and courteous manner. Displays concern and provides assistance or explains procedures as appropriate to callers or in face-to-face situations. Dedicated to meeting the expectations and requirements of internal and external customers. Works with customers to identify problem areas and recommend solutions.

POSITION QUALIFICATIONS (including required licenses/certifications, education and job knowledge/experience):

• High School Diploma required
• Associate Degree or equivalent training preferred
• Minimum 2 years experience as a utilization coordinator in a medical or hospital setting preferred.
• Availity knowledge preferred
• Excellent oral and written communication skills
• Excellent organizational skills and attention to detail
• Excellent time management skills with a proven ability to meet deadlines
• Ability to function independently with minimal supervision
• Basic computer skills