Utilization Review Coordinator

6 days ago


Willow Grove, Pennsylvania, United States Progressions Full time
Job Summary

We are seeking a highly skilled Utilization Review Coordinator to join our team. The successful candidate will be responsible for conducting continued stay reviews of medical record documentation using pre-established criteria and providing updated progress reports to third-party payers to receive certification for payment.

Key Responsibilities
  • Maintain accurate and thorough work logs of all reviews conducted with emphasis on documentation of service, days authorized, and authorization numbers
  • Perform concurrent continued stay reviews using pre-established criteria, understand ASAM criteria, and communicate this information accurately to insurance carriers
  • Consult with appropriate treatment team members for clarification of documentation as needed
  • Exchange information with Finance Office concerning insurance company requirements and all policies pertaining to certifications and appeals and inputs data accurately for financial purposes
  • Maintain accurate review sheets of all reviews performed
  • Helps supervisor and departments identify patterns of mis-utilization
  • Responds to telephone messages quickly, professionally, and appropriately
  • Participates in continuing education to reach professional growth objectives by attending in-services and other training opportunities
  • Participates in task forces and committees as assigned
  • Attends case conference for clinical updates
  • Maintains and communicates authorization information to all team members
  • Monitors/flags charts for high quality documentation when needed on a regular basis, regardless of reviews required
  • Educates new staff members about ASAM criteria, high-quality documentation, and insurance needs
  • Works in an environment with risk of exposure to communicable disease and possible exposure to intoxicated, disruptive, and/or agitated patients
  • Performs other duties as assigned
Requirements
  • Bachelor's degree (BA) in Behavioral Health or licensed as a Nurse (RN/LPN)
  • Knowledge of 12-step recovery and an understanding of chemical dependency
  • Knowledge of facility systems and organization as they pertain to medical records and organization review
  • Knowledge of medical terminology and medical record format and content
  • Excellent computer, internet, and business software skills
  • Excellent customer-facing and phone skills
  • Communication and interpersonal skills to develop relationships with patients, staff, and providers
  • Strong organization skills with a proven ability to multi-task and manage time to meet frequently changing deadlines in a fast-paced environment


  • Willow Grove, Pennsylvania, United States Progressions Full time

    Job SummaryProgressions is seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare team, you will be responsible for conducting continued stay reviews of medical record documentation using pre-established criteria and providing updated progress reports to third-party payers to receive certification...


  • Willow Grove, Pennsylvania, United States Progressions Full time

    Job SummaryProgressions is seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare team, you will be responsible for conducting continued stay reviews of medical record documentation using pre-established criteria and providing updated progress reports to third-party payers to receive certification...


  • Willow Grove, Pennsylvania, United States Resources For Human Development Full time

    Job Title: Behavioral Health Clinical CoordinatorJob Summary:This role is responsible for coordinating patient care activities and sharing information among all participants concerned with a patient's care to achieve safer and more effective treatment outcomes.Responsibilities:Develop and monitor program activities to ensure compliance with funder...


  • Willow Grove, Pennsylvania, United States Asplundh Full time

    About the RoleAsplundh is seeking a dedicated Human Resources Coordinator to join their team. This position requires a detail-oriented, proactive individual who can efficiently manage a variety of HR-related activities.Key ResponsibilitiesCorporate Training Events Coordination:Assist in planning and coordinating training events to enhance employee skills and...


  • Willow Grove, Pennsylvania, United States Asplundh Full time

    About the RoleAsplundh is seeking a dedicated Human Resources Coordinator to join their team. This position requires a detail-oriented, proactive individual who can efficiently manage a variety of HR-related activities.Key ResponsibilitiesCorporate Training Events Coordination:Assist in planning and coordinating training events to enhance employee skills and...


  • Willow Grove, Pennsylvania, United States Asplundh Full time

    Job Title: Internal Audit AssociateAsplundh is seeking a highly motivated and detail-oriented Internal Audit Associate to join our team. In this role, you will assist in conducting comprehensive internal audits and reviews to evaluate the effectiveness of financial, operational, and compliance controls.Key Responsibilities:Assist in developing and executing...


  • Willow Grove, Pennsylvania, United States Utilities Service Co Inc Full time

    About the RoleWe are seeking a highly organized and detail-oriented Administrative Assistant to join our HR Systems department at Utilities Service Co Inc.Key ResponsibilitiesProcess and analyze daily, weekly, and monthly reports to inform departmental decisions.Provide general administrative support, including attendance tracking, timesheet submissions, and...

  • RN Weekend Supervisor

    1 month ago


    Willow Grove, Pennsylvania, United States Garden Spring Nursing and Rehabilitation Center Full time

    Job Description:The Weekend RN Supervisor assumes 24-hour responsibility and accountability for the nursing care of all residents on an assigned unit at Garden Spring Nursing and Rehabilitation Center.Key Responsibilities:Supervises licensed nurses and other nursing personnel in the delivery of care and services according to each resident's comprehensive...


  • Willow Grove, Pennsylvania, United States TEKsystems Full time

    Job OverviewAs an Insurance Authorization Specialist at TEKsystems, you will play a critical role in ensuring seamless patient care by obtaining necessary documentation for insurance providers to continue qualified and authorized use of DME products.Key ResponsibilitiesDevelop a deep understanding of DME products and their application in patient...


  • Willow Grove, Pennsylvania, United States TheMasonGroup Full time

    Job SummaryWe are seeking a highly skilled Lead Estimator, Mechanical Systems to join our team at TheMasonGroup. As a key member of our custom estimation projects, you will be responsible for leading our estimation and proposal team, custom engineering systems, project coordination, implementation, execution, and completion of projects on time and on...

  • CNC Machinist

    5 days ago


    Willow Grove, Pennsylvania, United States Aerotek Full time

    About the RoleAerotek is seeking a skilled CNC Operator to join our team in Willow Grove, PA. As a CNC Operator, you will play a vital role in producing high-quality parts for our clients.Key ResponsibilitiesOperate CNC machinery to produce parts with precision and accuracyUtilize measuring gauges to ensure parts meet specificationsLoad parts into machinery...


  • Willow Grove, Pennsylvania, United States FASTSIGNS #290401 Full time

    Job OverviewFASTSIGNS #290401 is seeking a highly motivated and customer-focused Sales and Customer Service Representative to join our dynamic sales team. As a Sales Assistant, you will play a key role in supporting our sales team with all sales activity and project coordination.Key ResponsibilitiesWork closely with the sales team to generate leads and...

  • Forensic Chemist

    1 week ago


    Willow Grove, Pennsylvania, United States NMS Labs Full time

    Forensic Chemist Job DescriptionNMS Labs is seeking a highly skilled Forensic Chemist to join our team in Willow Grove, PA. As a Forensic Chemist, you will be responsible for performing chemical and analytical testing, including the isolation and identification of chemical substances in forensic casework samples.Key Responsibilities:Perform chemical and...


  • Willow Grove, Pennsylvania, United States Utilities Service Co Inc Full time

    Job Title: Senior Manager, Technical AccountingAs a Senior Manager, Technical Accounting, you will be responsible for leading the Technical Accounting team in performing technical accounting research and developing technical accounting positions and conclusions. You will also be responsible for monitoring and evaluating emerging accounting pronouncements and...


  • Willow Grove, Pennsylvania, United States ISH Dining Services Full time

    Job SummaryWe are seeking a highly skilled Clinical Dietitian to join our team at ISH Dining Services. As a Clinical Dietitian, you will play a vital role in providing medical nutrition therapy and evaluating the effectiveness of treatments in a long-term care setting.Key ResponsibilitiesDirectly provide nutrition services according to policies, procedures,...


  • Willow Grove, Pennsylvania, United States Asplundh Full time

    Customer Success Manager - Digital InnovationAsplundh Tree Experts is seeking a Customer Success Manager to join the Digital Innovation Team, reporting to the Director, Digital & Geospatial. This role is an excellent opportunity for a motivated individual to drive business solutions and projects, including the Vegetation & Asset Management Solution.Key...


  • Spring Grove, Pennsylvania, United States Pixelle Specialty Solutions Full time

    Job OverviewCompany Overview:Pixelle Specialty SolutionsTM is recognized as the largest specialty paper manufacturer in North America, boasting fully integrated pulp and paper operations across multiple locations. Our experienced product development team is dedicated to crafting tailored solutions that empower our clients to innovate and launch new products...


  • Willow Grove, Pennsylvania, United States Asplundh Full time

    About the RoleWe are seeking a highly skilled and experienced Financial Operations Manager, General Accounting to join our team at Asplundh. As a key member of our accounting team, you will be responsible for managing the General Accounting team, which is responsible for the month-end financial close process, including journal entries, accruals/estimates,...


  • Willow Grove, Pennsylvania, United States Asplundh Full time

    Job Title: Senior Manager, Financial ReportingAsplundh is seeking a highly skilled Senior Manager, Financial Reporting to join our team. In this role, you will be responsible for managing the Financial Reporting team within the accounting department, ensuring timely and accurate financial reporting to stakeholders.Key Responsibilities:Manage the Financial...


  • Willow Grove, Pennsylvania, United States TheMasonGroup Full time

    {"h1": "Job Title: Lead Estimator, Mechanical Systems", "h2": "Job Summary", "p": "We are seeking a highly skilled Lead Estimator to head our custom estimation projects at our Bucks County manufacturing facility. As a key member of our team, you will be responsible for leading our estimation and proposal team, custom engineering systems, project...