Utilization Review Coordinator
Posted on: August 1, 2022
Job Description Duties and Responsibilities: Initial
authorizations of outpatient physical therapy services: Reviews and
authorizes services that meet criteria, along with supporting
documentation. It is the responsibility of the URC to ensure
outpatient physical therapy services are provided at the
appropriate level and are received per the defined plan guidelines.
Re- authorization/concurrent review for continued therapy: Reviews
clinic documentation submitted by the provider to ensure services
continue to meet defined plan guidelines. Care Management : Reviews
all cases meeting criteria to determine if the member qualifies for
TPTN---s internal Care Management program. Will facilitate all Care
Management related communications being sent to the member.
Additional responsibilities include: Investigate and resolve
questions related to authorization and claims activity Assists in
maintaining department compliance with state, federal, HIPAA and
DOL regulations Assists in resolving issues relative to clinical
procedures Participates in monthly Health Services Meetings
Potential for limited local travel to attend Client Health Fairs
Qualifications and Experience : Individual must be results and goal
oriented. Must be self-directed and can communicate effectively,
both orally and in writing. Computer experience required: Word,
Excel, Internet. Two to five years of experience, preferably in a
managed care environment Working knowledge of the physical therapy
industry is a definite plus Strong written and verbal communication
skills Strong customer service skills/experience Strong computer
skills a must (Word, Excel, etc.) Independent, self-starter who is
results and goal oriented. Education: Healthcare professional with
an acquired background in physical therapy. Must possess an
Associate's Degree, Bachelor---s degree preferred. Experience in
lieu of a degree will be considered. Company Description
Exceptional Customer Service starts with having team members who
understand and embody collaboration and team work. It continues
every day with a positive, problem-solving approach to any issues
or concerns - regardless of how small and with continued expression
of appreciation for our team. What we do is so important.
Interested in joining us in that mission?
Keywords: TheraMatrix, Troy , Utilization Review Coordinator, Other , Troy, Michigan
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