Utilization review nurse Jobs in Glendale, AZ

Job Description

Job Description

The UR Authorization (Auth) Coordinator is the key position for reviewing admissions and utilization authorizations throughout Sanctuary facilities. The UR Auth Coordinator is responsible for reviewing clinical documentation, communicating with various sites, and securing and processing authorizations for inpatient, residential, and all other services that request payor authorization. The UR Auth Coordinator secures and monitors pre-certifications, concurrent reviews, retro reviews, and appeals to ensure that the members are getting timely, appropriate care. The UR Auth Coordinator serves as a communication liaison between Sanctuary Recovery Centers and the assigned payors. The UR Auth Coordinator will continue to seek knowledge of the industry, assigned payors, and maintain a strong knowledge of the overall departmental and organization functions.

Process and Practice Development

• Responsible for making recommendations for process improvements and report any barriers experienced by the UM department.
• Responsible for coordination of the flow of patients from medical management teams, completes referral in the EMR, collects medical records for completeness, identifies availability of appropriate bed placements and ensures timely review for acceptance / notification of denials.
• Ensures all coordination of care & authorizations are documented accordingly prior to departure of each shift.
• Responsible for maintaining call logs, productivity reports and status reports.
• Attends weekly staff meetings and at least one UM Team meeting per month in person.
• Protects each patient's confidentiality within the parameters of federal guidelines and established policy and process.
• Adheres to established policy and process for this assignment.
• Other duties as assigned by supervisory and administrative support.

Pre-certification of Services (Authorizations)

Skills / Requirements