Utilization Review Coordinator (REMOTE)

With this position you would have the ability to work from home!!

Shift: Monday-Friday 9:00 am - 5:00 pm

Deliverables/Principal Results Expected:

• Perform admission, continued stay and discharge reviews on all managed care clients.

• Maintain positive relationships with referral sources and insurance companies.

• Track admissions, continued stay and discharge PCPC requirements for county referrals.

• Maintain organized system of reporting to counselors when PCPC’s are due and when review calls are to be made.

• Maintain current insurance eligibility information through EVS, Navinet, etc.

• Monitor Census for accuracy of funding.

• Attend clinical staffing to obtain information for client reviews.

• Maintain daily UR database accurately.

• Perform Act 106 reviews and follow up appeals.

• Track all county referrals for documentation of admission calls.

• Maintain and participate in chart reviews to ensure proper paperwork is in place.

• Work directly with Billing Department to reduce uncovered days of funding. Investigate cases with insurance and referral sources to recuperate lost days of funding.

• Report to the Assessment Manager on a weekly basis.

• Manage all self-pay clients and clients with copays, deductibles, coinsurance and liabilities.

• Reduce client balances.

• Other duties as assigned.

Technical Competencies:

Provide the company with accurate information to ensure full financial coverage for each client day. Provide the referral source(s) with timely information to ensure good customer focus. Maintain client confidentiality and provide a safe therapeutic treatment. Knowledge of local, state and federal regulations. Knowledge of facility contracts and agreements. Knowledge of medical terminology, appeal and denial process, composition of medical records. Knowledge of data entry (primarily Excel) and mathematics. Knowledge of pre-certification process and PCPC. Knowledge of CARF standards, release of information and confidentiality. Knowledge of DSM IV, private care managers and county referral sources.

Total Rewards:

• Medical, Dental, and Vision Insurance
• Flexible Spending Accounts
• Life Insurance
• Paid Time Off
• 401(k) with Company Match
• Tuition Reimbursement
• Employee Recognition Programs
• Referral Bonus opportunities
• And More!

Pyramid CORE Values:

We are committed and proud to live our CORE values and use them to inspire those around us. Our employees are expected to align with these values, behaviors and standards. We are held accountable for upholding these CORE Values: INTEGRITY is striving to be honest, transparent and ethical when dealing with clients, staff and the community. DEDICATION is demonstrating an unwavering commitment to always provide exceptional care and support to those we serve is needed daily. COLLABORATION is a steadfast, team-focused approach; working together to achieve excellence. PASSION is genuine, compelling and relentless desire to improve lives and support Pyramid Healthcare’s mission.

Want to know more?

To learn more about Pyramid Healthcare, and how you can achieve personal and professional growth, visit us at: https://bit.ly/Pyramid-Careers.

Pyramid Healthcare, Inc. is proud of its diverse workforce, and is an Equal Opportunity Employer.