Utilization coordinator vs utilization review coordinator

Differences between utilization coordinator and utilization review coordinator duties and responsibilities

Utilization coordinator example responsibilities.

• Manage and coordinate authorization of denial letters and request for appeals with all levels of services.
• Manage and coordinate the workload of the release team members and are responsible for organizing and hosting all production release windows.
• Perform accurate verification of eligibility and benefits as well as advanced application of CPT, ICD-9 and ICD-10 codes.
• Assign accurate ICD-9 and CPT codes to request services for referral and authorization processing.
• Claim adjudication for assign HMO members.
• Provide orientation to pre-certification process for HMO, PPO, and POS members.
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Utilization review coordinator example responsibilities.

• Initial triage of members, administrative intake of members and managing the admission/discharge information post-notification.
• Identify and access Medicare entitlement benefits for those patients who meet eligibility requirements both prior to admission and during concurrent review.
• Include inpatient/outpatient acute setting, SNF, DME.
• Maintain a preventative maintenance schedule on all HVAC equipment.
• Coordinate transfers to SNF, ICF, and residential care.
• Assess patient medical needs using nationally recognize criteria sets such as InterQual.
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