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Become An Utilization Review Coordinator

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Working As An Utilization Review Coordinator

  • Assisting and Caring for Others
  • Documenting/Recording Information
  • Getting Information
  • Making Decisions and Solving Problems
  • Updating and Using Relevant Knowledge
  • Deal with People

  • Unpleasant/Angry People

  • Unpleasant/Hazardous Environment

  • Make Decisions

  • $67,490

    Average Salary

What Does An Utilization Review Coordinator Do At The Mentor Network

* Assistsin collection of service provision (planned, actual, over utilized) and currentservice information for program supervisor(s) for upcoming team meetings orservice change review meetings.
* ConductsService Authorization reviews and receives confirmation from programsupervisor(s) for approval of all pending and final service authorizations.
* Providesanalysis to assure that service delivery (planned to actual) correspond inareas of service support hours and units, staff hours and assignments, payrollhours and billing tickets, etc.
* Responsiblefor daily coordination and tracking systems of incoming service deliverydocumentation and corresponding billing tickets/pre invoice received forprocessing in the regional office.
* Performs weekly, bi-weekly, and monthlyreviews and verifies completeness of required information.
* Reports status ofvarious service delivery targets and projects outcomes to supervisor.
* Assistsin communication with Interdisciplinary Planning Teams to address areas ofidentified errors, corrections, or needed services related to billing units andover/under utilization areas.
* Assuresand maintains functional knowledge base and materials related to current andnew funding Rules and Contracts, provides updates and information to supervisorand/others specific to impact on service delivery, authorizations, andutilization of

What Does An Utilization Review Coordinator Do At Eating Recovery Center

* Respond to clinical inquiries in a timely, comprehensive and comforting fashion.
* Present Eating Recovery Center program information in a comprehensive and inviting manner.
* Collect comprehensive information regarding the inquiry; including clinical, professional collaboration and insurance.
* Work in conjunction with the marketing team to ensure high quality professional collaboration.
* Demonstrate personable and competent telephone communication skills.
* Interface with business office to ensure a positive admission experience, resources and to troubleshoot insurance concerns.
* Demonstrate ability to provide high quality assessment, diagnosis and recommendations.
* Demonstrate ability to intervene and motivate patients that need treatment.
* Demonstrate ability to build rapport resulting in converting inquires to admissions.
* Make referrals to outside providers/resources as indicated.
* Demonstrate detail oriented work through the necessary documentation, communication and coordination of admission.
* Demonstrate high quality verbal and written skills when presenting and conceptualizing a case to and with other staff.
* Conducts concurrent reviews with managed care organizations in a timely manner as requested.
* Attends regular treatment team meetings in order to share information and interact with the team.
* Prepares and submits appeals to managed care organizations.
* Other duties as assigned

What Does An Utilization Review Coordinator Do At Blue Cross Blue Shield of Massachusetts

* Conduct pre-certification, concurrent, and retrospective reviews when indicated and as allowed, for applicable product lines and levels of care, with emphasis on utilization management, discharge planning, coordination of services, clinical outcomes, and quality of services
* Evaluation of member's clinical status, benefit plan, and appropriateness for internal and external programs and sites of service in order to facilitate determination of cost-effective, medically necessary plan of care
* Interaction with treatment providers, PCPs, physicians, therapists, and facilities, as needed to support the plan of care
* Regular interactions with case managers, supervisors, managers, and physicians to discuss level of care questions, concerns, discharge needs, and barriers to achieving the most cost-effective, medically appropriate plan of care.
* Presentation of cases at rounds and follow-up with physicians as necessary to obtain physician input and achieve optimal outcomes
* Manage caseload to optimize attainment of goals around HEDIS measures, and other outcomes, quality, and accreditation metrics
* Adherence to program, departmental and organizational performance standards
* Knowledge of managed care and the health care landscape.
* A nuanced understanding of products, benefits, the healthcare delivery system, accreditation and regulatory requirements, and community resources is a key to consistent decision-making and working effectively within our company and program strategies

What Does An Utilization Review Coordinator Do At Maryland Treatment Centers, Inc.

* Reporting to the Utilization Review Nurse, the Utilization Review Counselor assists in implementing the facility's UR plan while maintaining compliance with all state, federal, and regulatory agency requirements.
* Conduct utilization reviews on all patients & document accordingly
* Regularly communicate with 3rd party reimbursement agencies
* Must be a counselor or have a valid trainee status.
* Competencies:
* Ability to understand and evaluate patient treatment
* Communicate effectively with Physicians
* Knowledge of federal & state regulatory agency requirements
* Must be savvy with electronic documentatio

What Does An Utilization Review Coordinator Do At St. Mary's Good Samaritan

* Enhances the overall patient care experience by responding to requests and obtaining needed services from other hospital personnel.
* Creates a positive environment for visitors by greeting them properly in person or on the phone, giving directions or referring inquiries to nursing and physician staff.
* Contributes to the overall financial performance of the department through efficient unit operations by following policies and procedures, reporting needed changes and maintaining unit supplies.
* Contributes to the overall financial performance of the department through efficient unit operations by following policies and procedures, reporting needed changes and maintaining unit supplies.
* Maintains a safe and clean environment by complying with procedures, rules and regulations and adhering to infection control policies and procedures as measured by the number of sentinel events or medical errors.
* Contributes to the overall employee satisfaction of the department by actively participating in staff meetings and offering assistance to others when needed

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How To Become An Utilization Review Coordinator

Registered nurses usually take one of three education paths: a Bachelor of Science degree in nursing (BSN), an associate’s degree in nursing (ADN), or a diploma from an approved nursing program. Registered nurses also must be licensed.


In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other social and behavioral sciences, as well as in liberal arts. BSN programs typically take 4 years to complete; ADN and diploma programs usually take 2 to 3 years to complete. All programs include supervised clinical experience.

Bachelor’s degree programs usually include additional education in the physical and social sciences, communication, leadership, and critical thinking. These programs also offer more clinical experience in nonhospital settings. A bachelor’s degree or higher is often necessary for administrative positions, research, consulting, and teaching.

Generally, licensed graduates of any of the three types of education programs (bachelor’s, associate’s, or diploma) qualify for entry-level positions as a staff nurse. However, employers—particularly those in hospitals—may require a bachelor’s degree.

Many registered nurses with an ADN or diploma choose to go back to school to earn a bachelor’s degree through an RN-to-BSN program. There are also master’s degree programs in nursing, combined bachelor’s and master’s programs, and accelerated programs for those who wish to enter the nursing profession and already hold a bachelor’s degree in another field. Some employers offer tuition reimbursement.

Clinical nurse specialists (CNSs) must earn a master’s degree in nursing and typically already have 1 or more years of work experience as an RN or in a related field. CNSs who conduct research typically need a doctoral degree.

Licenses, Certifications, and Registrations

In all states, the District of Columbia, and U.S. territories, registered nurses must have a nursing license. To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN).

Other requirements for licensing vary by state. Each state’s board of nursing can give details. For more information on the NCLEX-RN and a list of state boards of nursing, visit the National Council of State Boards of Nursing.

Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, and pediatrics, among others. Although certification is usually voluntary, it demonstrates adherence to a higher standard, and some employers require it.

CNSs must satisfy additional state licensing requirements, such as earning specialty certifications. Contact state boards of nursing for specific requirements.

Important Qualities

Critical-thinking skills. Registered nurses must be able to assess changes in the health status of patients, including determining when to take corrective action and when to make referrals.

Communication skills. Registered nurses must be able to communicate effectively with patients in order to understand their concerns and assess their health conditions. Nurses need to explain instructions, such as how to take medication, clearly. They must be able to work in teams with other health professionals and communicate the patients’ needs.

Compassion. Registered nurses should be caring and empathetic when caring for patients.

Detail oriented. Registered nurses must be responsible and detail oriented because they must make sure that patients get the correct treatments and medicines at the right time.

Emotional stability. Registered nurses need emotional resilience and the ability to manage their emotions to cope with human suffering, emergencies, and other stresses.

Organizational skills. Nurses often work with multiple patients with various health needs. Organizational skills are critical to ensure that each patient is given appropriate care.

Physical stamina. Nurses should be comfortable performing physical tasks, such as moving patients. They may be on their feet for most of their shift.


Most registered nurses begin as staff nurses in hospitals or community health settings. With experience, good performance, and continuous education, they can move to other settings or be promoted to positions with more responsibility.

In management, nurses can advance from assistant clinical nurse manager, charge nurse, or head nurse to more senior-level administrative roles, such as assistant director or director of nursing, vice president of nursing, or chief nursing officer. Increasingly, management-level nursing positions are requiring a graduate degree in nursing or health services administration. Administrative positions require leadership, communication skills, negotiation skills, and good judgment.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need registered nurses for jobs in health planning and development, marketing, consulting, policy development, and quality assurance.

Some RNs choose to become nurse anesthetists, nurse midwives, or nurse practitioners, which, along with clinical nurse specialists, are types of advanced practice registered nurses (APRNs). APRNs may provide primary and specialty care, and in many states they may prescribe medications.

Other nurses work as postsecondary teachers in colleges and universities.

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Utilization Review Coordinator jobs

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Utilization Review Coordinator Career Paths

Utilization Review Coordinator
Registered Nurse Case Manager Nursing Director
Chief Nursing Officer
14 Yearsyrs
Medical Coder Adjunct Instructor Clinical Social Worker
Clinical Care Manager
8 Yearsyrs
Utilization Review Nurse Registered Nurse Case Manager Nursing Director
Clinical Services Director
11 Yearsyrs
Nurse Staff Nurse Case Manager
Director Of Case Management
11 Yearsyrs
Director Of Case Management Managing Director Senior Recruiter
Director Of Human Resources
10 Yearsyrs
Home Health Nurse Nursing Director Clinical Coordinator
Director Of Pharmacist
10 Yearsyrs
Home Health Nurse Registered Nurse Supervisor Nursing Director
Director Of Quality Management
13 Yearsyrs
Career Manager Operations Manager General Manager
Director Of Sales
10 Yearsyrs
Nurse Case Manager Case Manager Account Manager
District Sales Manager
7 Yearsyrs
Medical Coder Nurse Career Manager
Managed Care Director
8 Yearsyrs
Director Of Case Management Social Worker Clinical Director
Medical Director
9 Yearsyrs
Registered Nurse Case Manager Clinical Supervisor Program Director
Operations Director
9 Yearsyrs
Utilization Review Nurse Staff Nurse Instructor
Operations Manager
7 Yearsyrs
Career Coordinator Assistant Director Of Nursing Registered Nurse Case Manager
Patient Care Manager
9 Yearsyrs
Nurse Case Manager Registered Nurse Case Manager Patient Care Manager
Patient Relations Director
10 Yearsyrs
Quality Assurance Coordinator Quality Assurance Account Manager
Regional Accounts Manager
8 Yearsyrs
Quality Assurance Coordinator Quality Assurance Manager General Manager
Regional Director Of Operations
11 Yearsyrs
Career Coordinator Program Manager Marketing Manager
Regional Sales Manager
9 Yearsyrs
Nurse Case Manager Program Manager
Senior Manager
10 Yearsyrs
Career Manager Clinical Supervisor Program Manager
Vice President, Business Development
13 Yearsyrs
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Utilization Review Coordinator Demographics


  • Female

  • Male

  • Unknown



  • White

  • Hispanic or Latino

  • Asian

  • Unknown

  • Black or African American

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Languages Spoken

  • Spanish

  • Portuguese

  • French

  • Braille

  • Tagalog

  • Italian

  • Indonesian

  • Dakota

  • Albanian

  • German

  • Urdu

  • Thai

  • Arabic

  • Cebuano

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Utilization Review Coordinator

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Utilization Review Coordinator Education

Utilization Review Coordinator

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Real Utilization Review Coordinator Salaries

Job Title Company Location Start Date Salary
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 20, 2013 $71,760
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 19, 2012 $71,760
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 20, 2011 $71,760
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 21, 2010 $71,760
Utilization Review Director NMS Healthcare of Hyattsville, LLC Hyattsville, MD Apr 01, 2011 $65,790
Utilization Review Coordinator Holzer Medical Center Jackson Jackson, OH Jan 27, 2011 $62,400
Utilization Review Coordinator Mission Hills Health Care Center San Diego, CA Oct 01, 2009 $61,859
Qa/Utilization Review Coordinator Jopal at St. James, LLC Saint James, NY Dec 15, 2011 $59,530
Utilization Review Coordinator Commonwealth Healthcare Corporation Apr 21, 2014 $42,000 -
Utilization Review Coordinator Commonwealth Healthcare Corporation Mar 24, 2014 $40,000 -
Utilization Review Coordinator Commonwealth Healthcare Corporation Apr 21, 2014 $40,000 -

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Top Skills for An Utilization Review Coordinator


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Top Utilization Review Coordinator Skills

  1. Private Insurance Companies
  2. Medical Records
  3. Medicaid
You can check out examples of real life uses of top skills on resumes here:
  • Worked on past denials to the University to recuperate payment utilizing my past expertise with private insurance companies.
  • Followed agency and regulatory professional standards for maintaining medical records.
  • Served as a point of contact for emergency prior authorization for Colorado Medicaid Prescription Benefit Management Program.
  • Conducted routine chart audits to ensure compliance with admission and continuing stay criteria and prepared summaries of audit findings.
  • Analyzed trends in both inpatient and outpatient medical services using historical insurance claims data.

Top Utilization Review Coordinator Employers

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Utilization Review Coordinator Videos

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

Utilization Review

Improving Core Measure Performance: The Impact of Concurrent Review