Intensive Specialty Hospital
Utilization Review Coordinator
Intensive Specialty Hospital, Shreveport, Louisiana, us, 71150
Utilization Review Coordinator
role at
Intensive Specialty Hospital Intensive Specialty Hospital is seeking a detail‑oriented and motivated Utilization Management Review Coordinator to support the authorization process for continued patient care. This position plays a vital role in ensuring medical necessity and compliance with insurance guidelines while helping patients receive timely and appropriate services. Key Responsibilities
Review patient charts and clinical documentation to evaluate medical necessity for continued care or services. Prepare and submit timely continuing authorization requests to insurance payers according to plan‑specific guidelines. Collaborate with physicians, nurses, care managers, and clinical staff to ensure accurate documentation and authorization alignment with the patient's care plan. Apply InterQual® and/or ASAM® criteria to guide authorization requests. Monitor and follow up on submitted authorizations to avoid denials. Communicate effectively with insurance representatives to resolve issues related to approvals or denials. Maintain accurate and up‑to‑date documentation of all utilization review activities in the electronic health record (EHR). Remain current with payer policies, state and federal regulations, and evidence‑based guidelines. Prioritize tasks to meet internal deadlines and external payer timeframes. Qualifications
Clinical experience in acute care, managed care, or behavioral health preferred. Basic understanding of utilization review and case management processes. Familiarity with InterQual® and/or ASAM® guidelines. Knowledge of managed care principles and insurance authorization processes. Excellent attention to detail, organizational skills, and time management. Proficient in EHR systems and Microsoft Office (Word, Excel, Outlook). Strong written and verbal communication skills. Seniority level
Entry level Employment type
Full‑time Job function
Health Care Provider Industries
Hospitals and Health Care
#J-18808-Ljbffr
role at
Intensive Specialty Hospital Intensive Specialty Hospital is seeking a detail‑oriented and motivated Utilization Management Review Coordinator to support the authorization process for continued patient care. This position plays a vital role in ensuring medical necessity and compliance with insurance guidelines while helping patients receive timely and appropriate services. Key Responsibilities
Review patient charts and clinical documentation to evaluate medical necessity for continued care or services. Prepare and submit timely continuing authorization requests to insurance payers according to plan‑specific guidelines. Collaborate with physicians, nurses, care managers, and clinical staff to ensure accurate documentation and authorization alignment with the patient's care plan. Apply InterQual® and/or ASAM® criteria to guide authorization requests. Monitor and follow up on submitted authorizations to avoid denials. Communicate effectively with insurance representatives to resolve issues related to approvals or denials. Maintain accurate and up‑to‑date documentation of all utilization review activities in the electronic health record (EHR). Remain current with payer policies, state and federal regulations, and evidence‑based guidelines. Prioritize tasks to meet internal deadlines and external payer timeframes. Qualifications
Clinical experience in acute care, managed care, or behavioral health preferred. Basic understanding of utilization review and case management processes. Familiarity with InterQual® and/or ASAM® guidelines. Knowledge of managed care principles and insurance authorization processes. Excellent attention to detail, organizational skills, and time management. Proficient in EHR systems and Microsoft Office (Word, Excel, Outlook). Strong written and verbal communication skills. Seniority level
Entry level Employment type
Full‑time Job function
Health Care Provider Industries
Hospitals and Health Care
#J-18808-Ljbffr