Utilization Review Coordinator PRN

Utilization Review Coordinator PRN

PRIMARY PURPOSE: To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Accesses, triages and assigns cases for utilization review (UR).
• Responds to telephone inquiries providing accurate information and triage as necessary.
• Enters demographics and UR information into claims or clinical management system; maintains data integrity.
• Obtains all necessary information required for UR processing from internal and external sources per policies and procedures.
• Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary.
• Supports other units as needed.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing High School diploma or GED required.

Experience Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred.

Skills & Knowledge

• Knowledge of medical and insurance terminology
• Knowledge of ICD9 and CPT coding
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Detail Oriented
• Good interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.