Utilization Review Coordinator jobs in Arizona
Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Recently Added Utilization Review Coordinator jobs
Utilization Review Coordinator
- Pinnacle Peak Recovery
-
Scottsdale, AZ
FULL_TIME
-
Are you looking for a change of pace? Do you have a passion for helping people?
Look no further! Pinnacle Peak Recovery is a mental health and substance use treatment provider located in Scottsdale, Arizona. If the following values are important to you then you will be a great fit for our company culture.- Compassion
- Fun
- Collaborate
- Integrity
Informed - Confident - Empowered - "Ice Ice Baby!"
Our program focuses on a comprehensive and holistic approach to overcoming addiction and mental health disorders in a safe, confidential, and supportive environment. We offer nationally recognized, evidence-based treatment options including MAT. Our clinic aspires to the highest level of care and is proud to have received accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
Position Overview: The Utilization Review Coordinator is an analytical, detail-oriented and organized professional responsible for all Utilization Review functions. The UR Coordinator is responsible for, but not limited to pre-certification, and initial and concurrent reviews for client’s treatment. This position works as part of the billing team and closely with the clinical and medical teams to act as a liaison between Pinnacle Peak Recovery and the insurance organizations.
Duties And Responsibilities- Reviews benefit verification with insurance organizations for covered services and precertification requirements.
- Inputs reviews into the Utilization Review calendar to ensure timely scheduling of reviews.
- Gather and analyze all information in client chart.
- Ability to review client records in depth and work with treatment team to gather required medical and clinical information to support client's admission and continued stay.
- Working knowledge of DSM IV Axis I-V, DSM V, ICD-10 and ASAM criteria.
- Broad understanding of dual-diagnosis issues and treatment protocols.
- Assess and distinguish levels of care for clients based on clinical and medical assessments and information using ASAM criteria.
- Coordinates obtaining signed releases of information for the patient to facilitate timely communication of clinical and medical information.
- Complete initial and concurrent reviews with insurance organizations as scheduled to ensure client level of care authorization and length of stay.
- On an ongoing basis, identify potential review problems and discuss them with supervisor and applicable departments.
- Coordinates peer to peer and/or doctor to doctor reviews with insurance organizations and medical and/or clinical treatment team.
- Document contact and outcomes of reviews with insurance organizations as indicated in a timely manner.
- Completes retro authorization appeals as needed.
- Creates, maintains, and tracks various utilization review reports.
- Able to interact with diverse client population.
- Assists with completing various client assessments.
- Assists with various chart audits and reports.
- Occasionally assists with insurance Verification of Benefits.
- Participate in department in-service/training programs and various staff meetings.
- Attend continuing education classes to maintain license and/or certification, if applicable.
- Complete special assignments and responsibilities as requested by supervisor.
- Performs other duties as assigned.
- Strong communication, including writing, speaking and active listening.
- Strong problem-solving and critical thinking skills.
- In-depth knowledge of insurance and best practices.
- Must be detail oriented and familiar with databases and extrapolating data.
- Strong interpersonal, organization, analytical, time management and prioritization abilities.
- Strong teamwork and organizational awareness.
- Excellent judgment and initiative.
- Functions as a core member of the health care team.
- Regularly communicate with other team members and interface in a positive, constructive, and helpful manner to promote collaboration, cohesiveness, reduce conflict, and provide for resolution.
- Able to work under pressure and meet deadlines as well as be flexible and dependable.
- Demonstrate the ability to understand and react effectively to the unique needs of the clients and team.
- Strong writing skills and understanding of clinical and medical terminology.
- Understanding of CPT, HCPCS, Revenue Codes, and insurance procedure guidelines.
- Strong understanding of DSM IV Axis I-V, DSM V, ICD-10 and ASAM criteria.
- Knowledge of Joint Commission standards. Strong knowledge and compliance of HIPAA, ethic, and legal protocols.
- Basic math and strong computer skills (Billing systems, Email, Microsoft Office Word, Excel, Teams, etc.)
- Ability to use standard office equipment such as copier, fax machine and other equipment as required.
- High School Diploma or GED equivalent required.
- Minimum 2 years’ experience working in Utilization Review.
45k-60k Base Salary - 17 Days Ago
Utilization Review Coordinator - PRN
- UHS
-
PHOENIX, AZ
PER_DIEM
- Responsibilities Utilization Review (UR) Coordinator Opportunity. Position: PRN (as needed) This position is on-site and cannot be done remotely. For nearly 60 years, Calvary Healing Center has provid...
- 20 Days Ago
Utilization Review Coordinator - PRN
- Calvary Healing Center
-
Phoenix, AZ
FULL_TIME
- Responsibilities: Utilization Review (UR) Coordinator Opportunity. Position: PRN (as needed) This position is on-site and cannot be done remotely. For nearly 60 years, Calvary Healing Center has provi...
- 22 Days Ago
Utilization Review Coordinator - PRN
- Universal Health Services, Inc.
-
Phoenix, AZ
FULL_TIME
- Responsibilities Utilization Review (UR) Coordinator Opportunity. Position: PRN (as needed) This position is on-site and cannot be done remotely. For nearly 60 years, Calvary Healing Center has provid...
- 20 Days Ago
Remote Utilization Review Specialist
- Billing Solutions LLC
-
Prescott, AZ
FULL_TIME
- Purpose of Position The role of the Utilization Review Specialist is to advocate for patient care at substance abuse treatment facilities by obtaining insurance authorizations for all levels of care. ...
- 2 Days Ago
Utilization Review Specialist - LEAD
- Sonora Behavioral Health
-
Tucson, AZ
FULL_TIME
- ESSENTIAL FUNCTIONS: Provide consultation and guidance regarding admissions and patient length of stay to a variety of payers. Secure authorizations with insurance companies for inpatient treatment an...
- 5 Days Ago
Utilization Review Coordinator jobs at Popular Companies
Utilization Review Coordinator (RN)
- Community Health System - CA
-
Fresno, CA
- Overview: *All positions are located in Fresno/Clovis CA* *Up to $25K in bonus incentives (sign-on and relocation)* Oppo...
- 6/10/2024 12:00:00 AM
Utilization Review Coordinator RN
- MyMichigan Health
-
Midland, MI
- Summary: This position plays a pivotal role in maintaining the fiscal health of the organization by ensuring the organiz...
- 6/9/2024 12:00:00 AM
HHS Utilization Review Coordinator - Behavioral Health
- Napa County, CA
-
Napa, CA
- Salary : $126,568.00 - $151,486.40 Annually Location : Napa, CA Job Type: Full Time Job Number: 2062-2023-11-02 Departme...
- 6/9/2024 12:00:00 AM
Utility Supervisor
- StarPlus Energy
-
Kokomo, IN
- Company Overview: STARPLUS ENERGY LLC is an electrifying joint venture between Samsung and Stellantis. With a focus on i...
- 6/9/2024 12:00:00 AM
Utilization Review Coordinator / Case Management / PRN
- Christus Health
-
Santa fe, NM
- Description POSITION SUMMARY: Registered Nurse uses approved screening criteria (MCG®/CMS Inpatient List) to determine t...
- 6/8/2024 12:00:00 AM
Utilization Review Coordinator
- COLLABORATIVE NEUROSCIENCE NETWORK LLC
-
Long Beach, CA
- Job Description Job Description Facility Overview At Ocean View Psychiatric Health Facility, we are committed to serving...
- 6/8/2024 12:00:00 AM
Utilization Coordinator
- Tenderheart Health Outcomes
-
Albany, NY
- Job Description Job Description For nearly two decades, TenderHeart (formerly known as Longhorn Health Solutions) has be...
- 6/8/2024 12:00:00 AM
Utilization Review Coordinator
- TheraMatrix
-
Pontiac, MI
- Job Description Job Description Duties and Responsibilities: Initial authorizations of outpatient physical therapy servi...
- 6/7/2024 12:00:00 AM
About Arizona
Arizona (/ˌærɪˈzoʊnə/ (listen); Navajo: Hoozdo Hahoodzo Navajo pronunciation: [xòːztò xɑ̀xòːtsò]; O'odham: Alĭ ṣonak Uto-Aztecan pronunciation: [ˡaɺi ˡʂonak]) is a state in the southwestern region of the United States. It is also part of the Western and the Mountain states. It is the sixth largest and the 14th most populous of the 50 states. Its capital and largest city is Phoenix. Arizona shares the Four Corners region with Utah, Colorado, and New Mexico; its other neighboring states are Nevada and California to the west and the Mexican states of Sonora and Baja California to the south and so...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$78,891 to $97,724
Most Popular Cities in Arizona for Utilization Review Coordinator Jobs
What does an Utilization Review Coordinator do?
Utilization Review Coordinator in Long Beach, CA
The Utilization Review Coordinator contributes to moderately complex aspects of a project.
January 05, 2020
Utilization Review Coordinator in Gary, IN
Candidates for this role must have a good understanding of medical terminologies, and stay tuned with latest developments in the field; they should possess knowledge of reviews such as MAC, KEPRO, and RAC; strong observing skills and the ability to monitor safety plans are also needed.
December 29, 2019
Utilization Review Coordinator in Chicago, IL
Including requirements, responsibilities, statistics, industries, similar jobs and job openings for Utilization Review Coordinator.
December 30, 2019