1 Utilization Review Coordinator (LPN or RHIT) Job in Livonia, MI
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Utilization Review Coordinator (LPN or RHIT)
$87k-105k (estimate)
Full Time
5 Days Ago
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Trinity Health MI is Hiring an Utilization Review Coordinator (LPN or RHIT) Near Livonia, MI
Employment Type:Full time
Shift:Description:RHIT or LPN
Does not require RN
Shift:Description:RHIT or LPN
Does not require RN
- Reviews assigned medical records in a timely manner for admission, concurrent or retrospective review using InterQual / MCG criteria to determine appropriate level of care.
- Follows the hospital Utilization Review Plan to ensure effective and efficient use of hospital services.
- Demonstrates competency with MCG and Interqual criteria.
- Analyzes and disseminates appropriate clinical information for payer authorization. Extracts pertinent information and communicates in a succinct fashion to the 3rd party payer. Demonstrates sound clinical judgement that supports IP level of care for appropriate reimbursement to the hospital.
- Demonstrates expertise in providing IS/SI criteria to Third Party Payers to obtain authorization for level of care and/or procedures for initial admission, concurrent or retrospective reimbursement.
- Contacts internal physician advisor on cases that do not meet established guidelines for admission or continued stay.
- In the event of an inpatient denial by the payer, obtains further documentation from the physician to support an IP level of care.
- Initiates and coordinates Peer to Peer discussions with physician and payer as warranted.
- Obtains authorizations as required for reimbursement from appropriate Third-Party Payor.
- Works with the Case Managers to obtain hospital to hospital transfer authorization as needed.
- Monitors the DNFB (discharged but not final billed) list to ensure timely claim filing.
- Communicates to the payer patient discharge date and discharge plan. Mediates between case manager and payer to ensure a seamless transition in care and appropriate post-acute follow-up.
- Provides updated Third-Party payor information to assigned Case Manager for continuity of care.
- Identifies areas of quality concerns, inappropriate use of resources and any other issues that restrict the implementation of hospital, department objectives and refers findings for appropriate follow-up.
- Reviews IP denials with the physician advisor to determine if a case should go to the Appeals Team.
- Assists other departments in the reimbursement process including, but not limited to, changes in inpatient, outpatient and observation status, identification of appropriate surgical status and other interventions needed to reduce patient and hospital liability of financial loss.
- Demonstrates proficiency in using various computer programs required including EPIC, Availity, Word, and Payor Portals.
- Responsible for combining admissions on those cases that are appropriate and communicating to Insurance Verification and Health Information Management.
- Functions as a resource to physician, hospital staff or departments and other ‘customers” of the hospital to assist in complying with the utilization review processes.
- Participates in UR Committee, department staff meetings and ad hoc committees on an as needed basis.
- Participates in review and analysis of outcome data related to UR functions and identification of system and process issues that contribute to denials.
Job Summary
JOB TYPE
Full Time
SALARY
$87k-105k (estimate)
POST DATE
06/22/2024
EXPIRATION DATE
06/21/2024
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The following is the career advancement route for Utilization Review Coordinator (LPN or RHIT) positions, which can be used as a reference in future career path planning. As an Utilization Review Coordinator (LPN or RHIT), it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Coordinator (LPN or RHIT). You can explore the career advancement for an Utilization Review Coordinator (LPN or RHIT) below and select your interested title to get hiring information.
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