Job Description
Are you looking for a role where you can make a meaningful impact while working from the comfort of your home? Join our team as a Utilization Review Coordinator, where you'll collaborate with insurance providers, referral sources, and internal teams to ensure clients receive the care and support they need.
Schedule:
Monday to Friday, 9:00 AM - 5:00 PM
What You'll Do:
As a Utilization Review Coordinator, you will:
Conduct admission, continued stay, and discharge reviews for managed care clients.
Build and maintain positive relationships with referral sources and insurance companies.
Monitor compliance with county referral requirements and track PCPC requirements.
Organize reporting systems to keep counselors informed of review deadlines.
Keep insurance eligibility information up to date using tools like EVS and Navinet.
Monitor census data to ensure funding accuracy.
Participate in clinical staffing to gather information for client reviews.
Accurately maintain the utilization review (UR) database.
Handle Act 106 reviews and manage follow-up appeals.
Document admission calls for county referrals.
Participate in chart reviews to ensure all required paperwork is in place.
Collaborate with the billing department to minimize uncovered funding days and recover lost funding.
Manage self-pay clients and oversee client liabilities, copays, deductibles, and balances.
Provide regular updates to the Assessment Manager.
Take on additional duties as assigned to support the team.
What You Bring:
To thrive in this role, you'll need:
Strong knowledge of medical terminology, pre-certification processes, and PCPC requirements.
Understanding of local, state, and federal regulations related to healthcare.
Proficiency in data entry (especially Excel), mathematics, and reporting.
Familiarity with CARF standards, medical records composition, appeals and denials, and confidentiality practices.
Excellent communication and organizational skills, with a focus on customer service.
What We Offer:
Enjoy a comprehensive benefits package designed to support your well-being and professional growth:
Medical, dental, and vision insurance
Flexible spending accounts
Life insurance
Paid time off (PTO)
401(k) with company match
Tuition reimbursement
Employee recognition programs
Referral bonus opportunities
And more!
What We Value:
Our team is guided by core values that inspire excellence and compassion in everything we do:
Integrity: We uphold honesty, transparency, and ethics in all interactions.
Dedication: We're committed to providing exceptional care and support every day.
Collaboration: We work together as a team to achieve excellence.
Passion: We have a relentless desire to improve lives and make a difference.
Ready to Apply?
We're excited to welcome compassionate, detail-oriented individuals to our team. Take the next step in your career and make a difference in the lives of others!
Equal Opportunity Commitment
We celebrate diversity and are proud to be an equal opportunity employer.
Employment Type: Full-Time
Salary: $ 75,000.00 Per Year
Job Tags
Full time, Local area, Remote job, Flexible hours, Monday to Friday,