3 Utilization Review Coordinator Jobs in Springfield, OR
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Monte Nido & Affiliates is Hiring an Utilization Review Coordinator Near Springfield, OR
- Conduct all utilization reviews and peer reviews as needed and appropriately document following company protocols.
- Obtain information from clinical staff as needed to conduct utilization reviews, peer reviews, pre-certifications, and argue single case agreements.
- Communicate with clinical staff regarding status of client authorization.
- Communicate with billing regarding billing/claims issues and status of single case agreements as needed.
- Communicate with admissions regarding status of client authorization, potential denials, and potential for private payment.
- Conduct pre-authorizations for clients changing level of care.
- Follow standardized clinical documentation across programs.
- Writing letters of appeal for denials.
- Communicate emerging trends with insurance companies to clinical director.
- Maintain database of on insurance company clinical care guidelines, APA guidelines, medical necessity criteria and other necessary documents and clinical ammunition to support UR process.
- Keep up to date on insurance expectations/changes annually.
- Deliver care in a non-judgmental and non-discriminatory manner, sensitive to patient and staff diversity.
- Seek corrective criticism and evaluate suggestions objectively.
- Maintain acceptable overall attendance.
- Promote a favorable/positive work atmosphere.
- Attend in-services and educational training as necessary and as assigned.
- Seek out learning experiences and incorporate new knowledge into practice.
- Maintain flexibility and adaptability to expected and unexpected changes in the work environment.
- Report incidents, accidents, and occurrences in accordance with policies and procedures.
- Maintain safety of the physical environment.
- Comply with facility policies and procedures
- Master’s Degree in Psychology, Social Work, Nursing, or mental health-related field required
- At least one year of experience relating to insurance authorizations and managed care
- Licensed behavioral health clinician/provider preferred
Job Summary
Full Time
Ambulatory Healthcare Services
$71k-91k (estimate)
02/03/2023
05/04/2023
montenido.com
Miami, FL
500 - 1,000
Ambulatory Healthcare Services
Related Companies
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