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Utilization review coordinator skills for your resume and career

Updated January 8, 2025
3 min read
Utilization review coordinator example skills
Below we've compiled a list of the most critical utilization review coordinator skills. We ranked the top skills for utilization review coordinators based on the percentage of resumes they appeared on. For example, 18.4% of utilization review coordinator resumes contained patients as a skill. Continue reading to find out what skills a utilization review coordinator needs to be successful in the workplace.

15 utilization review coordinator skills for your resume and career

1. Patients

Here's how utilization review coordinators use patients:
  • Identified and accessed Medicare entitlement benefits for those patients who met eligibility requirements both prior to admission and during concurrent review.
  • Coordinated the intensive Case Management program monitoring patients with high utilization to ensure appropriate outpatient care was obtained by the patient.

2. Patient Care

Patient care entails the diagnosis, recovery, and control of sickness as well as the maintenance of physical and emotional well-being through the use of healthcare providers' services. Patient care is described as services provided to patients by health practitioners or non-professionals under guidance.

Here's how utilization review coordinators use patient care:
  • Coordinate with discharge planning through active organization and monitoring of the patient care process to promote continuity of care cost effectiveness
  • Coordinate patient care between physicians and insurance companies, verify insurance protocol for inpatient hospital stays

3. Acute Care

The branch of secondary healthcare which is responsible for giving short-term care to patients recovering from severe injuries or urgent medical problems is known as acute care. Acute care comprises multiple domains like; emergency care, urgent care, short-term stabilization, pre-hospital care, critical care, and trauma care.

Here's how utilization review coordinators use acute care:
  • Monitored acute care provided to members utilizing McKesson InterQual criteria.
  • Conducted all diagnosis coding for the facility including, acute care SNF, rehab, E.R., short stay and ambulance.

4. Utilization Management

Here's how utilization review coordinators use utilization management:
  • Assist with utilization management quality assurance initiatives through participation in on-line log and/or case staffing with supervisor.
  • Trained and consulted with staff on utilization management matters, assuring state and federal regulatory compliance.

5. Discharge Planning

Here's how utilization review coordinators use discharge planning:
  • Identified quality concerns/appropriateness of inpatient medical necessity for HMO/POS members length of stay and facilitated discharge planning when appropriate.
  • Work performance also included discharge planning during inpatient hospitalization and coordinating home health care services prior to hospital discharge.

6. Social Work

Here's how utilization review coordinators use social work:
  • Developed case management system to incorporate functions of utilization review, clinical social work, and referral source communications.
  • Provided social work services for the emergency department, including utilization review problems and emergency transfers.

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7. Mental Health

Mental health is the state of wellbeing in which an individual can cope with the regular stresses and tensions of life, and can work productively without having any emotional or psychological breakdown. Mental health is essential for a person of any age and helps them make the right decisions in their life.

Here's how utilization review coordinators use mental health:
  • Provided review of mental health treatment requests for inpatient to outpatient psychiatric care for military family members and retired military members.
  • Peer reviewer for psychologists requesting approval for providing mental health treatment and psychological testing on an outpatient basis.

8. Home Health

Here's how utilization review coordinators use home health:
  • Utilize various sources to verify patient insurance eligibility for DME and Home Health Care.
  • Initiated a joint venture with Home Health Services and Durable Medical Equipment Company.

9. Medicaid

Here's how utilization review coordinators use medicaid:
  • Participated in multiple outside agency surveys Medicaid Field Office, clinical reviews of internal processes and by other authorized government agencies.
  • Reviewed Medicare and Medicaid patient records for quality of care, utilization of resources and appropriate assignment of Diagnosis Related Groups

10. Utilization Review

Another name for utilization review is utilization management. It is the process of ensuring that healthcare services are used in a suitable manner. Utilization review is a critical component of adding value to the health care system. Mostly, UR is carried out by healthcare insurance companies, but hospitals and other healthcare providers also perform the process. Utilization review has three types of assessment namely: concurrent, prospective, and retrospective.

Here's how utilization review coordinators use utilization review:
  • Prepared statistics and presented Medicare Regulations to various hospital department, including the Hospital Utilization Review Committee and Outpatient Advisory Committee.
  • Performed utilization review for renowned eating disorder facility to en- sure quality and procure funds to fuel operations.

11. Appeals

Here's how utilization review coordinators use appeals:
  • Conducted insurance appeals for treatment coverage via written and telephonic forms of communications.
  • Prepared/correlated appeals for retroactive denials by third party players for appropriate committee action.

12. Concurrent Review

Here's how utilization review coordinators use concurrent review:
  • Manage insurance process for 24-bed in-patient psychiatric facility including admission authorization, concurrent reviews, ECT authorization and Partial Hospitalization step-downs.
  • Collaborated with attending physicians, concurrent review staff, social services and other ancillary providers.

13. Substance Abuse

Here's how utilization review coordinators use substance abuse:
  • Monitored commercial insurance compliance with Pennsylvania state mandated benefits for substance abuse treatment.
  • Work with third-party payers to ensure appropriate payment and utilization of Valley Hope substance abuse treatment services.

14. Data Entry

Data entry means entering data into a company's system with the help of a keyboard. A person responsible for entering data may also be asked to verify the authenticity of the data being entered. A person doing data entry must pay great attention to tiny details.

Here's how utilization review coordinators use data entry:
  • Process included reviewing for medical necessity, criteria, benefit interpretation, insurance eligibility, and data entry.
  • Research and data entry using multiple systems and complete tasks as assigned.

15. Outpatient Services

Here's how utilization review coordinators use outpatient services:
  • Provide first level clinical review for all inpatient and outpatient services requiring authorization for assigned client group regarding:
  • Monitored and authorized outpatient services according to established guidelines.
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List of utilization review coordinator skills to add to your resume

Utilization review coordinator skills

The most important skills for a utilization review coordinator resume and required skills for a utilization review coordinator to have include:

  • Patients
  • Patient Care
  • Acute Care
  • Utilization Management
  • Discharge Planning
  • Social Work
  • Mental Health
  • Home Health
  • Medicaid
  • Utilization Review
  • Appeals
  • Concurrent Review
  • Substance Abuse
  • Data Entry
  • Outpatient Services
  • Peer Review
  • Rehabilitation
  • Clinical Data
  • Review Process
  • Clinical Documentation
  • CPT
  • Medical Services
  • CMS
  • HIPAA
  • Medical Necessity Criteria
  • SNF
  • Patient Charts
  • Federal Regulations
  • Hospital Admissions
  • Chart Review
  • Inpatient Admissions
  • Interqual Criteria
  • Insurance Benefits
  • Retrospective Reviews
  • Computer System
  • Care Organizations
  • ICD-9
  • Durable Medical Equipment
  • Milliman
  • Clinical Review
  • Hippa
  • Eating Disorders
  • Medical Documentation
  • PHP
  • DRG
  • ASAM
  • Private Insurance
  • Medical Review

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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