Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Pinnacol Assurance does just one thing, and does it better than anyone: provide caring workers’ compensation protection to Colorado employers and employees. And while we may be a little biased, we believe that our work shapes communities and changes lives.
We have big hearts and love big ideas. We’ve been around for more than 100 years, but don’t let that fool you. Pinnacol is committed to taking care of Colorado employers and workers in the most innovative ways. We celebrate continuous improvement, new ideas, compassion, teamwork, integrity and excellence.
With our number one priority to keep everyone safe, along with the heart of Pinnacol’s “culture of caring” to do what is right and not what is easy, we’re currently having our team members work from home. But we’re still making time for fun with virtual events like virtual painting classes, virtual yoga and Zumba classes, and virtual happy hours!
What you’ll do:
Responsible for helping to establish a new utilization review (UR) department within Pinnacol. Key areas of focus include carrying out reviews of medical records and prior authorization requests to determine the clinical necessity and appropriateness of medical services that have been requested or previously furnished. To inform these reviews, follows standardized protocols informed by evidence-based guidelines and similar literature. Communicates with community medical providers to request information and provide education. Shares pertinent information with independent physician advisors who make final payment (coverage) determinations. Communicates with injured workers about coverage decisions. Collaborates with bill pay processors to ensure that approved and denied services are paid appropriately. Collaborates as needed with medical nurse case managers, claims adjustors, and other internal and external stakeholders. Supports and participates in a transition towards increasing UR efficiency and automation by taking advantage of new software that streamlines workflows and helps manage information and communication.
What you can expect:
Additional Duties:
What you need to be successful:
When we find the right person, we try to put our best foot forward with an offer that excites you. We consider what you’d like to be paid, the skills and experience you bring, what similar jobs pay in the Denver area and make sure there’s equal pay for equal work among those you’ll be working with. The compensation amount for this role is targeted at $49,700-$53,700/yr. Final offer amounts are determined by multiple factors including your experience and expertise and may vary from the amounts listed above.
Want to love your work? Apply today!
Pinnacol is committed to working with and providing reasonable accommodations to applicants with disabilities. To request assistance with the application process, please email recruiting_team@pinnacol.com.
This posting will close 15 days from after being published. It is scheduled to close on March 11th, 2024.
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