Utilization review coordinator vs managed care coordinator

Differences between utilization review coordinator and managed care coordinator duties and responsibilities

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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Managed care coordinator example responsibilities.

• Manage ICD-9 coding and DRG validation for high volume of claims.
• Ensure all clinical operations comply with Medicare and Medicaid guidelines and other manage care policies.
• Manage caseload by providing care coordination to individuals with a primary intellectual/developmental disability diagnosis all of whom receive community-base waiver services.
• Adhere to all state, accreditation standards and regulatory guidelines which include HIPAA guidelines and NCQA accreditation.
• Enter and approve authorizations for patients being discharge from hospitals to a sub- acute rehabilitation facility or a skil nursing facility.
• Review ICD-9 and HCPCS codes to insure proper coding used on claims.
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