What are the responsibilities and job description for the Utilization Review Coordinator position at Cayuga Health System?
Utilization Review Coordinator - Full Time - Days / Evenings
Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs.
The Utilization Review (UR) Coordinator ensures efficient utilization management across Cayuga Health System by monitoring admissions, level of care determinations, and medical necessity denials while ensuring compliance with CMS regulations. This role supports the UR Committee, facilitates peer-to-peer discussions and appeals, and collaborates with providers to secure proper authorizations. Additionally, the UR Coordinator oversees Swing Bed PDPM reporting and billing, ensuring accurate HIPPS code submissions to maintain compliance and optimize reimbursement
Roles and Responsibilities:
- Demonstrates knowledge of medical necessity criteria and guidelines. Assist in the prospective,
concurrent, and retrospective review of clinical cases to identify the most appropriate level of
care based on nationally recognized criteria and standards of care. - Monitors patient status, collaborating with patient access and providers to ensure alignment
with physician orders. - Participates in the analysis of Utilization trends and makes recommendations as indicated.
- Serves as a resource for the CRM team, and system at large, in daily concurrent review activities.
- Assists Director in the education of physician offices related to trends found in the surgical
authorization process and related to authorization standard requirements communicated from
third party payers. - Implements and oversees the Clinical Resource Management medical necessity denial process.
Assures ongoing tracking and trending of denial information and appeal activities. - Maintains current knowledge of regulatory and compliance requirements for utilization
practices, policies and procedures.
Required Skills and Experience:
- Experience - Minimum 2 to 3 years' experience in an acute care hospital setting or equivalent health
care experience. Knowledge of federal, state and accreditation standards - Licensure - Current unrestricted NY state RN licensure.
Preferred Skills and Experience:
- Graduate of an Accredited school of nursing, BSN preferred
Physical Requirements:
- Repetitive use of hands and fingers (e.g., Use of computer keyboard); may require lifting and carrying light loads (up to 40 lbs), including boxes, equipment, IV solutions and stooping and kneeling (e.g., to pick up items from the floor, to remove and replace items on lower shelves and to file documents in lower file drawers); sitting, walking, or standing for long periods of time may be necessary; must be able physically to operate the equipment used for the job.
Location and Travel Requirements:
- Onsite at 101 Dates Dr, Ithaca NY 14850
- Less than 25% Travel
- One 12 hour shift per week with some weekend and holiday requirements
Pay Range Disclosure:
- $83,280 to $98,280 annually based on experience
Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.
We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.
If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at talentacquisition@cayugahealth.org.
Salary : $83,280 - $98,280
