Utilization Review Coordinator

Full Time, Non-Clinical

Magee Rehabilitation Hospital opened in 1958 as the first free-standing rehabilitation hospital in Philadelphia. The Hospital has over 600 employees and is nationally recognized for outstanding programs in physical and cognitive rehabilitation, with comprehensive services for spinal cord injury, brain injury, stroke, orthopedic replacement, amputation, pain management and work injury. Magee serves as the federally designated Regional Spinal Cord Injury Center of Delaware Valley. Only 14 such centers exist in the country. Magee is a founding member of The Christopher Reeve Foundation NeuroRecovery Network, which provides state of the art rehabilitation therapy.

We are currently seeking a Utilization Review Coordinator to screen the medical records of patients for determination of appropriate utilization of hospital resources. This individual acts as a liaison for patient information between third party payers, Medical staff, and administration. Works collaboratively with Case Managers, Therapists, Manager of Utilization Review and Medical Staff.

Essential Accountabilities:

  • Responsible for the ongoing review of all patients assigned upon admission
  • Responsible for ongoing communication with Case Managers regarding cases that will need to be appealed
  • Responsible for writing and submitting timely appeals to third party payers as needed
  • Processes late pick-up after Third Party Coverage has been exhausted
  • Maintains logs and statuses of each denial/appeal and provides data to the UR Manager
  • Contacts Physicians and Manager of Utilization Review as needed regarding possible utilization problems.
  • Identifies all cases of extended duration by requesting feedback from Case Managers, Program Directors, and Physicians.
  • Maintains and reviews the Federal Length of Stay Report (FEDLOS) daily.
  • Participates on the Utilization Management Committee
  • Responsible for all reviews to be completed timely, and documented properly in both the AR Detail Screen and the Utilization Management Module in CPSI.
  • Participates in weekly Utilization Management Staff meeting

Additional Accountabilities:

  • Performs other related duties as assigned by the Manager of Utilization Review
  • Maintains records of all reviews and correspondence with third party payers.
  • Maintains records of all status of reconsiderations or appeals.

Qualifications:

  • Bachelor's degree in Nursing or related field preferred
  • Over one year experience in Utilization Management in a healthcare setting

Department Specific Competencies:

  • Demonstrates ability to gain cooperation of physicians, therapists and other personnel as necessary
  • Verbal and written ability is required to interpret goals and status effectively across interdisciplinary lines
  • Must know medical terminology

Magee Rehabilitation Hospital is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.

Mail, Email or fax your resume to:

Human Resources
Magee Rehabilitation Hospital
1513 Race Street
Philadelphia, PA 19102
Employment@Mageerehab.org
Fax Number: (215) 587-9471