Utilization Review Authorization Coordinator - REMOTE

The Utilization Review Authorization Coordinator will work with RN Case Managers and other facility staff to coordinate the appropriate information and actions necessary to ensure proper authorizations are obtained for care of patients. Identify denial patterns and works with DCM and Care Management Team to positively impact outcomes.

KEY RESPONSIBILITIES:

• The Utilization Review staff assumes primary responsibility of communicating with payors to obtain authorization.
• Attention to detail regarding documentation and follow-up to ensure process completed timely.
• Effectively interact with all levels of the organization and maintain cooperative relations with internal and external customers.
• Coordinates with UR RN to send the clinical information to payor on specific accounts.
• Document authorization numbers, concurrent denial, attempts to overturn concurrent denials and coordinate Peer-to-Peer communication as needed for all patient hospital stays.
• Follow-up communication with payors to ensure authorization obtained for patient hospitalization.
• Communicate appropriately with Care Manager and Social Worker regarding authorization status and payor requests.

REQUIRED KNOWLEDGE & SKILLS:

• Good organizational skills.
• Ability to assist in development and process improvement in obtaining payor authorization and concurrent denial appeals.
• Manages time effectively, sets priorities, and consistently meets deadlines.
• Excellent verbal and written communication skills.
• Ability to effectively interact with insurance companies. 
• Demonstrates initiative and pro-active approach to problem resolution.
• Performs well independently and on a team.
• Assumes accountability for demonstrating behaviors consistent with the customer service policy.
• Works competently with computer based charting and other clinical and non-clinical software programs. Readily adapts to change.
• Understands Medicare and Medicaid coverage details.
• Operates office equipment efficiently.
• Critical thinking skills required.
• Utilizes independent judgment and discretion in the UR Coordinator role.
• Understand CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRGs.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

1. Education: Minimum High School graduate or GED equivalent.
2. Experience (Type & Length):  Two 2 - 4 years’ experience in healthcare preferred.
3. Certification/Licensure:  None.
4. Software/Hardware:  Basic computer knowledge required, i.e. Word, Excel, Microsoft Office
5. Other:  Understanding of the health care delivery setting. Ability to read and communicate effectively in English required, ability to communicate in additional languages preferred.

About Steward Health Care
Nearly a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.
As the country's largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.
Steward is among the nation’s largest and most successful accountable care organizations (ACO), with more than 5,500 providers and 43,000 health care professionals who care for 12.3 million patients a year through a closely integrated network of hospitals, multispecialty medical groups, urgent care centers, skilled nursing facilities and behavioral health centers.
Based in Dallas, Steward currently operates 33 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas.

Steward Health Care is proud to be a minority, physician owned organization. Diversity, equity, inclusion and belonging are at the foundation of the care we provide, the community services we support and all our employment practices. We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.