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UR Coordinator

2 months ago

Grand Forks, North Dakota, United States UHS Full time
Job Summary

We are seeking a highly skilled Utilization Review Coordinator to join our team at UHS. As a key member of our Behavioral Health department, you will play a critical role in ensuring the efficient and effective management of patient care.

Key Responsibilities
  • Initiate Pre-Certification Calls: Establish and maintain relationships with private insurance and managed Medicare and Medicaid plans to secure pre-certification for patient stays.
  • Conduct Concurrent Reviews: Monitor patient progress and provide ongoing reviews to ensure compliance with insurance requirements.
  • Manage Insurance Appeals: Collaborate with the facilities denial management coordinator to resolve insurance-related issues and appeals.
  • Communicate with Treatment Teams: Share treatment recommendations and participate in interdisciplinary team meetings to ensure seamless patient care.
  • Provide Resources and Suggestions: Offer guidance to third-party payors on aftercare and discharge continued care options.
  • Stay Informed on Legislative and Insurance Changes: Continuously update knowledge on legislative and insurance changes affecting continued stay requirements.
  • Represent Payor Sources: Stay informed on all clinical services and program changes to effectively represent payor sources.
  • Disseminate Findings and Data: Share pertinent information with referral sources as needed.
Benefits
  • Competitive Compensation
  • Excellent Medical, Dental, Vision, and Prescription Drug Plan
  • 401(K) with Company Match and Discounted Stock Plan
  • Long and Short-term Disability
  • Flexible Spending Accounts; Healthcare Savings Account
  • Life Insurance
  • Career Development Opportunities
  • Tuition Assistance
  • Rewarding Work Environment
Requirements
  • Bachelor's Degree Required
  • At Least 3 Years of Related Experience Required