UR Coordinator

We are seeking a Utilization Review (UR) Coordinator to join our team. The UR Coordinator is a healthcare professional who bridges the gap between medical providers, patients, and insurance companies. They evaluate medical records to ensure that patient treatments meet established clinical guidelines, secure insurance authorizations, and manage healthcare costs while maintaining quality care.

Essential Duties:

·         Prior Authorization & Certification: Submitting clinical documentation to health insurance to approve planned procedures, hospital admissions, or continued stays

·         Medical Necessity Evaluation: Reviewing patient charts to ensure the level of care matches the patient's condition and meets both regulatory and insurance standards

·         Compliance & Auditing: Ensuring all medical documentation adheres to HIPAA and insurance regulations

·         Liaison Duties: Acting as a central point of contact between clinical staff, billing departments, and third-party payers

·         Treatment Team Collaboration: Attends interdisciplinary treatment team to gather clinical justifications, track therapy progress,