UR COORDINATOR

POSITION REQUIREMENTS/QUALIFICATIONS

1. EDUCATION:

Master's degree from an accredited college or university in social work, mental health, nursing, or related degree Required.

2. EXPERIENCE:

Knowledge of behavioral health systems and Utilization Management required.

Two years of UR experience in a hospital or healthcare insurance setting required.

3. LICENSURE/CERTIFICATION:

LMSW, LMHC, LPC, or other healthcare related licensure preferred

4. AGE SPECIFIC INDIVIDUALS SERVED/ RESPONSIBILITY:

Adult

5. SECURITY MEASURERS AND CLEARANCE:

Background check (level per current regulation) completed, reviewed and approved by the Governing Body.

6. EMPLOYEE CLASSIFICATION:

Exempt

WORKPLACE ENVIRONMENT

1. ENVIRONMENTAL CONDITIONS:

Position requires work in a temperature-controlled environment; 80% - 90% of the time spent indoors.

No potential exposure to violent situations.

No potential exposure to airborne/blood-borne pathogens or other potentially infectious materials.

2. MACHINES/EQUIPMENT USED:

Computer Fax Machine

Xerox Machine Telephone System

3. PHYSICAL & MENTAL DEMANDS:

4. JOB CATEGORY STANDARD PRECAUTIONS:

Routine tasks involve no exposure to blood, body fluids, or tissues (although situations may arise in which the employee might encounter potential exposure to any of the above).

5. PERSONAL PROTECTIVE EQUIPMENT:

None

6. POTENTIAL WORKPLACE HAZARDS:

None

7. POTENTIAL WORKPLACE VIOLENCE:

Medium Level

SPECIFIC AREAS OF RESPONSIBILITY TO POSITION

1. Obtaining preauthorization for admissions and continued stays according to third party guidelines within one business day of admission (unless otherwise required), including researching and obtaining any necessary insurance contact information, and coordinating scheduled meetings between hospital and insurance doctors.
2. Managing and performing the processes for retrospective authorizations and denials/appeals.
3. Timely communicating preauthorization outcomes, follow-up instructions, options, and related information to relevant administrative and clinical staff. This includes responding to all calls and emails within one business day unless otherwise required.
4. Documenting activity in Billing and UR software, and preparing reports for meetings and management review.
5. Organizing and filing documents for ease of access in approved locations.
6. Assisting in compiling information for data analysis relating to preauthorization and reimbursement.
7. Providing assistance to facility staff in determining the likelihood of insurances covering treatment.
8. Maintaining patient confidentiality in accordance with state and federal law.
9. Participating in internal information meetings, required in-service education and training, and company-wide performance improvement and compliance activities.
10. Other duties as assigned