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Utilization Review Coordinator
2 months ago
Torrance Memorial Medical Center is seeking a highly skilled and detail-oriented Utilization Review Assistant to join our team. As a key member of our Utilization Review department, you will play a critical role in ensuring that all utilization management documentation and information requirements are met.
Key Responsibilities- Liaison and Communication: Act as a liaison between the department, hospital departments, physicians, office staff, and other relevant stakeholders to foster clear communication and collaboration.
- Resource Coordination: Compose lists of resources for Case Managers and Social Workers as needed.
- Referral and Authorization Management: Confer with assigned nurses regarding the need for additional hospital services or referrals and assist with the referral process.
- Department Statistics and Reporting: Coordinate department statistics and forward information to the budget department and director.
- Quality Improvement: Deliver daily the QI0 2nd letter to MCARE patients 48 hours prior to discharge for compliance with the CMS.
- Payer Communication: Ensure payer communication with reference numbers and authorizations for benefits coverage for any outside services, including MCARE.
- Error Reporting: Report errors in a non-punitive environment, promoting a positive culture for error correction.
- Denial Mitigation: Collaborate with other departments and teams to mitigate potential denials.
- Documentation and Compliance: Ensure timely and accurate completion of payer and repatriation documentation, retrospective review requests, WQM management, and post-stabilization documentation.
- Audit Response: Respond to audit requests in a timely manner and escalate to the appropriate team for review and response.
- Experience: 2 years of experience in Utilization Management, Case Management, Business Office, Revenue Cycle, or other applicable healthcare experience.
- License/Certification: California Licensed Vocational Nurse.
- Compensation: $24.16 - $36.31 per hour.
