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Become An Utilization Review Coordinator

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Working As An Utilization Review Coordinator

  • $58,000

    Average Salary

What Does An Utilization Review Coordinator Do At Unitedhealth Group

* Respond to incoming provider faxes and calls Develop relationships within the provider community and health services team Resolve service inquiries which could include: Notification entry, Providers status of an existing notification and determining if notification is required, Complete notification wizard along with ICD
* and CPT coding, and Research of provider concerns and issues Manage incoming calls from providers, managing requests for services from providers and Plan staff.
* Organize work and develop strategies to adapt to constantly changing workload as evidenced by: Performing multiple administrative tasks while concurrently triaging phone calls and incoming faxes and Timely response to provider and care coordination team needs Document within the clinical documentation system administrative actions, follow-up and key attributes necessary to track member setting of care and reportable indices.
* Responsible for the resolution of escalated calls that are received by the UR team.
* Document Member/Provider responses and call outcomes in CareOne as appropriate.
* Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance

What Does An Utilization Review Coordinator Do At Phoenix House

* Complete assessments and pre-certifications
* Complete utilization, discharge, and peer reviews
* Initiate and resolve appeals
* Ensure EMR is up to date and complete
* Utilize ASAM criteria to identify and advocate for appropriate level of care placement
* Develop and maintain effective relationships with stakeholders including current and prospective referral sources, insurers/pay sources, Phoenix House clinical and medical staff and management
* Advocate on behalf of Phoenix House and its clients with insurers/pay sources and others regarding treatment protocols, medical necessity issues, and quality of care matters
* Ensure that both effective utilization management and client experience standards are maintained
* Train staff on insurance utilization review and authorization procedures, and other managed care concerns to ensure prompt and effective information-sharing and service documentation
* Responsible for consistent and timely reporting on key business metrics

What Does An Utilization Review Coordinator Do At Sedgwick Claims Management Services

* Accesses, triages and assigns cases for utilization review (UR).
* Responds to telephone inquiries proving accurate information and triage as necessary.
* Enters demographics and UR information into claims or clinical management system maintains data integrity.
* Obtains all necessary information required for utilization review processing from internal and external sources per policies and procedures.
* Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
* Supports other units as needed.
* ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned.
* Supports the organization's quality program(s

What Does An Utilization Review Coordinator Do At UHS-Dover Behavioral

* Conduct admission reviews working with Assessment and Referral Services to stay abreast of admissions.
* Conduct concurrent and extended stay reviews on appropriate day and/or specified time.
* Prepare and submit appeals to third party payors, effectively coordinating collection of all pertinent data to support the hospital and patient s position.
* Maintain and update logs of review and maintain other appropriate records of the Utilization Review department.
* Stay abreast of applicable UR trends.
* Communicate pertinent third party payors issues to doctor and treatment team.
* Attend daily treatment team meetings to discuss acuity issues, third party payors needs and gather information for reviews.
* Work independently in gathering information for reviews from the patient record, taking the initiative to seek information from members of the treatment team.
* Understand and communicate insurance information to team members, including benefits and levels of care offered.
* Perform internal utilization reviews as indicated.
* Master s prepared in a behavioral health major or an actively licensed State of Delaware Registered Nurse.
* Experience in UR preferred.
* Associated topics: activity, after school, county, fws, group, instructor, leader, resident, vacation

What Does An Utilization Review Coordinator Do At Amerihealth Caritas

* Under the direction of the unit Supervisor, the Clinical Reviewer is responsible for completing medical necessity reviews.
* Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review.
* It is within the nurse’s discretion to pend requests for additional information and/or request clarification.
* The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed.
* The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met.
* The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit’s business and uses clinical judgment in their application.
* This position will be based in our Des Moines, Iowa office

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Utilization Review Coordinator Career Paths

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Do you work as an Utilization Review Coordinator?

Average Yearly Salary
$58,000
Show Salaries
$32,000
Min 10%
$58,000
Median 50%
$58,000
Median 50%
$58,000
Median 50%
$58,000
Median 50%
$58,000
Median 50%
$58,000
Median 50%
$58,000
Median 50%
$103,000
Max 90%
Best Paying Company
LifePoint Health
Highest Paying City
San Francisco, CA
Highest Paying State
New Jersey
Avg Experience Level
3.0 years
How much does a Utilization Review Coordinator make at top companies?
The national average salary for an Utilization Review Coordinator in the United States is $58,259 per year or $28 per hour. Those in the bottom 10 percent make under $32,000 a year, and the top 10 percent make over $103,000.

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Top Skills for An Utilization Review Coordinator

  1. Utilization Review Activities
  2. Insurance Companies
  3. Treatment Plans
You can check out examples of real life uses of top skills on resumes here:
  • Oversee utilization review activities with other departments to ensure reimbursement for services provided.
  • Relay therapeutic information to insurance companies in order to authorize coverage of treatment for inpatient and outpatient chemical dependency treatment.
  • Collaborated with clinical staff to develop effective treatment plans, including measurable goals, evidence-based interventions, and appropriate aftercare planning.
  • Organized medical records and confidential data and prepared accounts receivable and expected revenue reports for controllers.
  • Participated in implementing / maintaining operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.

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Top 10 Best States for Utilization Review Coordinators

  1. Rhode Island
  2. New York
  3. District of Columbia
  4. New Hampshire
  5. New Jersey
  6. Connecticut
  7. Massachusetts
  8. Wyoming
  9. Washington
  10. Maryland
  • (41 jobs)
  • (449 jobs)
  • (70 jobs)
  • (63 jobs)
  • (188 jobs)
  • (107 jobs)
  • (313 jobs)
  • (17 jobs)
  • (226 jobs)
  • (194 jobs)

Utilization Review Coordinator Resume Examples And Tips

The average resume reviewer spends between 5 to 7 seconds looking at a single resume, which leaves the average job applier with roughly six seconds to make a killer first impression. Thanks to this, a single typo or error on your resume can disqualify you right out of the gate. At Zippia, we went through over 2,385 Utilization Review Coordinator resumes and compiled some information about how best to optimize them. Here are some suggestions based on what we found, divided by the individual sections of the resume itself.

Learn How To Create A Top Notch Utilization Review Coordinator Resume

View Resume Examples

Utilization Review Coordinator Demographics

Gender

Female

71.2%

Male

15.6%

Unknown

13.2%
Ethnicity

White

61.5%

Hispanic or Latino

16.4%

Black or African American

12.6%

Asian

6.2%

Unknown

3.3%
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Foreign Languages Spoken

Spanish

57.1%

French

7.1%

Braille

4.8%

Tagalog

4.8%

Italian

4.8%

German

2.4%

Portuguese

2.4%

Albanian

2.4%

Hmong

2.4%

Greek

2.4%

Urdu

2.4%

Thai

2.4%

Arabic

2.4%

Cebuano

2.4%
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Utilization Review Coordinator Education

Schools

University of Phoenix

25.2%

Walden University

5.6%

Capella University

5.6%

Florida International University

5.2%

Grand Canyon University

4.4%

University of South Florida

4.0%

University of Saint Francis

4.0%

Nova Southeastern University

4.0%

Excelsior College

4.0%

Strayer University

4.0%

Kaplan University

4.0%

University of Oklahoma

4.0%

Virginia Commonwealth University

3.6%

Wayne State University

3.2%

Arizona State University

3.2%

Georgia State University

3.2%

University of Texas at Arlington

3.2%

University of Memphis

3.2%

Florida State University

3.2%

Webster University

3.2%
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Majors

Nursing

38.2%

Business

11.6%

Health Care Administration

9.0%

Social Work

6.4%

Psychology

4.9%

Counseling Psychology

3.3%

Mental Health Counseling

3.2%

School Counseling

3.1%

Management

2.6%

Computer Information Systems

2.4%

Education

2.1%

Criminal Justice

2.0%

Public Health

1.7%

Communication

1.7%

Medical Assisting Services

1.7%

Clinical Psychology

1.5%

English

1.3%

Human Services

1.1%

General Studies

1.1%

Liberal Arts

1.1%
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Degrees

Bachelors

29.9%

Masters

29.4%

Associate

14.9%

Other

14.8%

Certificate

3.7%

Doctorate

3.4%

Diploma

2.7%

License

1.1%
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