Utilization Review Coordinator

1 month ago


Olathe, Kansas, United States KVC Health Systems Full time

{"Job Title": "Utilization Review Specialist", "Job Summary": "We are seeking a highly skilled Utilization Review Specialist to join our team at KVC Health Systems. As a key member of our treatment team, you will be responsible for managing patient interactions with health plans, including initial, concurrent, and discharge reviews. This role requires strong communication skills, attention to detail, and accuracy in a fast-paced environment.", "Responsibilities": "\u2022 Engage in respectful and inclusive teamwork with all KVC departments and employees\u2022 Work effectively with a wide range of constituencies, including but not limited to a multi-disciplinary internal team, external stakeholders, referral sources, other care providers, and insurance companies in a diverse community\u2022 Ensure and monitor correct data is in electronic health records with authorizations/child specific contracts (single case agreements, etc.)\u2022 Gather data and compile information completely and accurately and enter data into the data management systems\u2022 Conducts Utilization Review functions; reports to insurance companies; files appropriate forms and writes appeals for signature\u2022 Gather and summarize information for intake assessments and discharge summary reports\u2022 Maintain strictest confidentiality about child/youth/adult/family information\u2022 Assist in maintaining compliance with state, federal and The Joint Commission guidelines\u2022 Will assist with completion of paperwork for admissions and assist in other duties\u2022 Will assist with individual assignments such as audits of meaningful use data\u2022 Attends staff conferences and in-service training as required or needed\u2022 Provide reviews of documentation to enhance quality of records and ensure compliance with standards of care\u2022 Support special initiatives through quality assurance roles to enhance services for consumers\u2022 Other duties may be assigned\", "Requirements": "\u2022 A Bachelor's degree in a human services field (I.e., social work, education, sociology, psychology, counseling, applied behavioral sciences) or criminal justice preferred\u2022 High school diploma or GED required\u2022 A minimum of two years' experience working in case management, utilization review, wellness coordination with at least one of those years of experience working with economically disadvantaged, vulnerable or at-risk youth and/or adults\u2022 Requires Intermediate skills in Microsoft Office Suite, including Word, Excel, and Outlook email. Strong interpersonal skills including oral and written communication\u2022 At least 21 years old\u2022 Valid Drivers License\u2022 Valid Auto Insurance\", "Company Culture": "We're an equal opportunity employer committed to diversity and inclusion. We welcome applications from individuals of all backgrounds and experiences.", "Benefits": "\u2022 Competitive salary\u2022 Comprehensive benefits package\u2022 Opportunities for professional growth and development\"}


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