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Become An Utilization Coordinator

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Working As An Utilization Coordinator

  • Interacting With Computers
  • Getting Information
  • Making Decisions and Solving Problems
  • Communicating with Supervisors, Peers, or Subordinates
  • Processing Information
  • Deal with People

  • Mostly Sitting

  • $52,630

    Average Salary

What Does An Utilization Coordinator Do At QTC Management

* Consistent and effective communication with IPA providers and operations
* Ability to effectively utilize reports and tools to communicate IPA provider schedules to the providers and to communicate and escalate information and trends to VAO
* Proactively communicate issues/concerns with IPA provider schedules proactively to VAO leadership teams as necessary
* Ability to coordinate with regional utilization manager (RUM) on IPA utilization issues
* Responsible for building and adjusting provider’s schedules
* Constantly evaluates the utilization of dedicated IPA providers
* Prevention of gaps and overbooking in provider’s electronic schedules
* Time slot capitalization which includes communication with operations scheduling staff
* Effective management of electronic confirmation systems (i.e.eMessenger, Pega communicator, ACD) in order to minimize no show rates
* Efficiently utilizes electronic tools and workflows in order to manage resources such as: ECW, UCM, eProcess and other tools as necessary
* Ability to prioritize operations and provider’s requests when and if necessary
* Any other duties as assigned

What Does An Utilization Coordinator Do At Sanford Health

* HOURS
* Full-time, 40 hours a week.
* The UM Coordinator will be required to work primarily day hours, but may be required to work some evenings to ensure contact with case managed members.
* Manage and complete authorization within the work queues; Assist with and manage Insurance Denials; Review medical policies and review for medical necessity for scheduled procedures; Verify insurance coverage through established methods; Perform other duties as assigned.
* Works in an office environment and basically telephonic/computer; May occasionally have face to face contact with members in the office setting

What Does An Utilization Coordinator Do At Rochester Regional Health

* Track and monitor all denials, appeals, arbitration responses to payers/audits
* Initiate an E HR 1st, 2nd, and/or arbitration appeals as needed.
* Document in all areas that an appeal has been initiated or no appeal is necessary per E HR reviews.
* Reconcile E HR inpatient medical necessity denials.
* Receive E HR determination letters and forward to Utilization Review Specialists and/or HIM.
* Review MVP authorization and morning list daily to determine if clinical update is needed, and/or patient was discharged.
* Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer

What Does An Utilization Coordinator Do At CN Utility Consulting

* Serve as liaison for environmental permitting related to Utility Vegetation Management
* Prepare Utility Vegetation Management budgets, plans work, track expenditures
* Assist with scheduled and emergency aerial patrols
* Manage contractor productivity, safety, quality of work, and customer satisfaction
* Lead and coordinate all activities related to compliance with Utility Vegetation Management reliability standards
* Oversee vegetation cycle program
* Manage hazard tree program in assigned region
* Resolve customer complaints and property damage issues
* Travel required throughout Kentucky to oversee contractor performance
* Perform other related duties as required or assigned

What Does An Utilization Coordinator Do At NYU Medical Center

* Identify and develop methods to optimize patient outcomes related to medication quality measures
* Review charts, analyze claims and work with physicians and health plans to review medications for appropriateness, duplications, adherence and compliance, while consulting with patients as necessary
* Develop strategies and targeted interventions to manage high cost drug utilization and improve prescribing practices
* Partner with prescribers to improve utilization by providing recommendations and education
* Collaborate with registered nurse Clinical Care Coordinators to refer patients for health coaching, receive referrals and perform medication coaching/reconciliation
* Maintains a close relationship to the Pharmacy & Therapeutics committee, reporting outcomes, data and trend analyses to both the Clinically Integrated Network and the committee
* Visits practices on regular basis to discuss data and trends
* Assist physicians with individual clinical decision making as requested
* Develop clinical interventions, educational programs, tools, policies and clinical guidelines to support disease management and improve medication appropriateness
* Identify resources and community partners to support disease management initiatives and patient adherence
* Provide pharmacy support to internal/external healthcare professionals as subject matter expert
* Identify and discuss medication utilization trends with prescribers, and propose interventions to improve performance
* Conduct comprehensive medication reviews/medication reconciliation for patients referred by clinical team or identified by trigger reports
* Report outcomes, and trend analyses to appropriate clinical committees for NYUPN and NYU Langone IPA
* Develop clinical interventions, track activity, performance improvement and identify new opportunities relating to medication adherence and utilization
* Demonstrates knowledge of the organizations Service Standards and incorporate them into the performance of duties
* Coach, mentor and precept pharmacy students and residents
* Sees professional development opportunities and participates in projects/activities to maintain professional competence (seminars, journals, 15 hours of continuing education credit per year required by NYS)
* Ensure compliance with all regulations
* Perform other duties as assigned

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Utilization Coordinator jobs

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Utilization Coordinator Career Paths

Utilization Coordinator
Billing Specialist Specialist
Account Manager
5 Yearsyrs
Career Coordinator Service Director Human Resources Coordinator
Business Office Manager
8 Yearsyrs
Construction Manager Senior Project Manager Business Developer
Chief Executive Officer
8 Yearsyrs
Manager Billing Specialist Collector
Collections Manager
5 Yearsyrs
Billing Specialist Office Administrator Human Resources Coordinator
Director Of Human Resources
10 Yearsyrs
Project Manager Program Manager General Manager
District Manager
7 Yearsyrs
Manager Owner Chef
Food And Beverage Manager
5 Yearsyrs
Nurse Nursing Director Branch Manager
Manager, Assistant Vice President
7 Yearsyrs
Utilization Review Coordinator Nurse Program Manager
Managing Director
11 Yearsyrs
Registered Nurse Staff Nurse
Nursing Director
9 Yearsyrs
Specialist Account Manager Sales Manager
Office Manager
5 Yearsyrs
Construction Manager Operations Manager
Operations Director
9 Yearsyrs
Project Manager Construction Manager
Operations Manager
7 Yearsyrs
Nurse Senior Technician Specialist Accounts Payable Clerk
Payroll Manager
7 Yearsyrs
Career Coordinator Therapist Clinical Manager
Practice Administrator
10 Yearsyrs
Utilization Review Coordinator Utilization Review Nurse Registered Nurse Case Manager
Practice Manager
9 Yearsyrs
Case Manager Program Coordinator
Program Manager
8 Yearsyrs
Specialist Operations Manager
Purchasing Manager
9 Yearsyrs
Registered Nurse Case Manager Program Manager
Senior Manager
10 Yearsyrs
Case Manager Program Manager
Senior Project Manager
12 Yearsyrs
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Utilization Coordinator Demographics

Gender

  • Female

    67.3%
  • Male

    31.2%
  • Unknown

    1.5%

Ethnicity

  • White

    79.5%
  • Hispanic or Latino

    12.5%
  • Asian

    5.4%
  • Unknown

    2.0%
  • Black or African American

    0.5%
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Languages Spoken

  • Spanish

    67.6%
  • Swedish

    2.9%
  • Samoan

    2.9%
  • Hawaiian

    2.9%
  • Japanese

    2.9%
  • French

    2.9%
  • Carrier

    2.9%
  • Tagalog

    2.9%
  • Serbian

    2.9%
  • Polish

    2.9%
  • Arabic

    2.9%
  • Croatian

    2.9%
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Utilization Coordinator

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Utilization Coordinator Education

Utilization Coordinator

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Top Skills for An Utilization Coordinator

UtilizationManagementDepartmentComplianceConcurrentReviewDataEntryCustomerServiceMedicalNecessityReviewDischargePlanningMedicare/MedicaidUtilityCompaniesUtilizationReviewInsuranceCompaniesSafetyMedicalRecordsPatientCareHealthPlanMembersInterqualUtilityCoordinatorCPTClinicalInformationMedicalManagement

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Top Utilization Coordinator Skills

  1. Utilization Management Department
  2. Compliance
  3. Concurrent Review
You can check out examples of real life uses of top skills on resumes here:
  • Charleston, WV Utilization Management Department When hired at Shawnee Hills Inc.
  • Interacted with providers, members or hospitals/facilities to communicate determination outcomes in compliance with state, federal and accreditation requirements.
  • Identify admissions which require concurrent review and forward to case managers.
  • Assist Data Entry with entry and verification when necessary.
  • Answer phone calls professionally and demonstrate customer service skills.

Top Utilization Coordinator Employers

Utilization Coordinator Videos

It Happens Here: A Day in the Life of Aralis Tavarez

Utilization Review

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