UR Coordinator

Utilization Review Coordinator

The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with patients' treatment. Reviews treatment plans and status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. Monitors the appropriateness of hospital admissions and extended hospital stays. Completing data collection of demographics, claim and medical information; non-medical analysis; and outcomes reporting. May consult with staff as needed.

Essential Duties :

Evaluate patient medical records to assess the appropriateness and quality of care provided.

Verify the accuracy and completeness of documentation to support medical necessity.

Analyze treatment plans and interventions to ensure they align with patient needs and best practices.

Collaborate with healthcare providers to make recommendations for adjustments or improvements in treatment plans.

Verify insurance coverage and benefits to determine eligibility for services.

Communicate with insurance providers to obtain authorization for services as needed.

Conduct utilization reviews to monitor and optimize the use of healthcare resources.

Identify and address any utilization patterns that may indicate inefficiencies or deviations from standards of care.

Maintain accurate and detailed records of utilization review activities and outcomes.

Prepare reports and summaries of findings for internal review and compliance purposes.

This job description is not intended to be all-inclusive. Employee may perform other related duties to meet the ongoing needs of the hospital. Duties may be modified or changed with or without notice.