Utilization Review Department Coordinator

Trinity Health; Fort Lauderdale (FL); On-site; USD 45,000 - 75,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Utilization Review Coordinator to manage essential back-office functions. In this role, you will interface with payors and providers, ensuring that authorizations and medical records are handled efficiently. Your ability to promote teamwork and maintain professional communication will be crucial in this position. Join a diverse and inclusive organization committed to providing equitable care and making a difference in the lives of patients. This is an exciting opportunity to contribute to a mission-driven team while advancing your career in healthcare.

Qualifications

• Experience in Utilization Review processes and healthcare management.
• Strong communication skills for effective collaboration.

Responsibilities

• Manage back-office functions of the Utilization Review Department.
• Interface with payors and providers for authorizations and medical records.
• Coordinate Physician Advisor referrals and ensure seamless communication.

Skills

Utilization Review

Communication

Teamwork

Office Management

Education

Bachelor's Degree in Healthcare or related field

Job description

Employment Type:

Full time

Shift:

Not specified

Description:

Under the direction of the Care Coordination Department Leadership, the Utilization Review (UR) Coordinator manages all back-office functions of the Utilization Review Department. This role involves interfacing with payors and providers to request authorizations, medical records, and other information, as well as confirming the completeness of reviews and directing concurrent denials appropriately.

1. Interface with payors and providers requesting authorizations, medical records, and other specific information.
2. Manage all clinical review work queues assigned to Utilization Management diligently.
3. Coordinate Physician Advisor referrals when there are concerns regarding meeting level of care criteria, utilizing Indicia/InterQual, and review these referrals with the department manager as needed.
4. Report uncovered or at-risk days to the leadership of Utilization Review.
5. Promote teamwork by working effectively both as a team member and independently. Communicate and collaborate with Utilization Management RNs, care managers, nursing staff, secretaries, insurance representatives, and others as needed.
6. Ensure seamless communication with payers by retrieving voicemails and faxes, and transcribing information into the electronic medical record. Maintain professional and positive communication at all times.
7. Perform basic reception functions to ensure smooth office operations, including answering calls, maintaining filing systems, managing office supplies, and ensuring office equipment is serviced.
8. Perform other duties as assigned.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on our Mission and Core Values, we incorporate diversity, equity, and inclusion into all aspects of our work. Our colleagues have diverse lived experiences, customs, abilities, and talents, enabling us to provide accessible and equitable care. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected status by law.