Utilization Management Coordinator

What You'll Do:

The Utilization Management Coordinator pursues and secures authorizations from any and all payers. Ensures appropriate utilization of services at Connections Health Solutions clinics, observation and inpatient units. Facilitates maximum appropriate payment through support of concurrent review of inpatient care by any payer. Obtains prior authorization for service as required.

• Works with all payers to secure authorization for inpatient stays for all individuals admitted to Inpatient or COE Unit.
• Performs utilization review in accordance with all Payor requirements, State Regulations, and Joint Commission Standards. Ensures all payer utilization management staff receive needed daily information to perform their reviews.
• Obtain authorizations for previously identified procedures where required.
• Reviews medical records and evaluates patient progress towards discharge. Performs continuing review on medical records and identification and need for on-going inpatient services. Obtains necessary medical reports, treatment plans and validates BHMP’s progress notes/evaluations for appropriate justifications of continued stay.
• Documents review information as required by State and Payor regulations. Communicates results