About

UR Coordinator - Nursing Precertification/Authorization

Job Code: 159900
Reports To: HIM Manager
FLSA Status: Non-Exempt
Department: HIM

RN or LPN
Status: Fulltime or Part-time
Schedule: M-F

Position Summary


Duties include identifying enrollees that have a need for precertification/preauthorization by coordinating and performing precertification, out of network precertification, retrospective review, reconsideration, and appeals. Performs each review process following the appropriate policy and procedure and with standard time frames.

Basic Skills


-Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
-Talking to others to convey information effectively.
-Understanding written sentences and paragraphs in work-related documents.
-Communicating effectively in writing as appropriate for the needs of the audience.
-Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

Social Skills


-Adjusting actions in relation to others' actions.
-Actively looking for ways to help people.
-Being aware of others' reactions and understanding why they react as they do.

Resource Management Skills


-Managing one's own time.
-Obtaining and seeing to the appropriate use of equipment, facilities, and materials needed to do certain work.

Desktop


-Databases - Using a computer application to manage large amounts of information, including creating and editing simple databases, inputting data, retrieving specific records, and creating reports to communicate the information.
-Graphics - Working with pictures in graphics programs or other applications, including creating simple graphics, manipulating the appearance, and inserting graphics into other programs.
-Internet - Using a computer application to create, manipulate, edit, and show virtual slide presentations.
-Navigation - Using scroll bars, a mouse, and dialog boxes to work within the computer's operating system. Being able to access and switch between applications and files of interest.
-Presentations - Navigating the Internet to find information, including the ability to open and configure standard browsers; use searches, hypertext references, and transfer protocols; and send and retrieve electronic mail (email).
-Spreadsheets - Using a computer application to enter, manipulate, and format text and numerical data; insert, delete, and manipulate cells, rows, and columns; and create and save worksheets, charts, and graphs.
-Word Processing - Using a computer application to type text, insert pictures, format, edit, print, save, and retrieve word processing documents.

Task


-Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise.
-Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families, and providers.
-Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to:
- Promote improved quality of care and/or life
- Promote cost-effective medical outcome
- Prevent hospitalization when possible and appropriate
- Proved for continuity of care
- Assure appropriate levels of care are received by patients
-Provide appropriate consultation and referral to Revenue Cycle Committee.
-Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available resources.
-Maintain accurate records of all interventions and provides timely verbal and written reports to the Revenue Cycle Committee.
-Prepare monthly cost savings and management reports.
-Assist with the preparation of quarterly summary reports.
-Maintain accurate records of all communications and intervention logs.

Work Activities


-Interacting With Computers
-Getting Information
-Communicating with Persons Outside Organization
-Processing Information
-Establishing and Maintaining Interpersonal Relationships
-Organizing, Planning, and Prioritizing Work
-Communicating with Supervisors, Peers, or Subordinates
-Making Decisions and Solving Problems
-Updating and Using Relevant Knowledge
-Evaluating Information to Determine Compliance with Standards

Detailed Work Activities


-Answer telephones to direct calls or provide information.
-Enter information into databases or software programs.
-Communicate with employees, patients, or others to collect information.
-Maintain records.
-Prepare business correspondence.
-Prepare documentation for regulatory compliance.
-Provide information to coworkers.
-Provide notifications to staff, patients, or others.
-Review customer insurance information.
-Verify the accuracy of financial or transactional data.

Education/Experience


-A Graduate of an accredited school of nursing.
-Current Nebraska licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN)
-Preferred 3 years of healthcare experience.
-Preferred prior UR experience.

Language Ability


-Ability to read, write, interpret, present, analyze, correspond general business journals, procedures, regulation is required.
-Bilingual beneficial, although not required.

Supervisory Responsibilities


This job has no supervisory responsibilities.

Work Environment/Physical Demands


- Noise level is minimal to moderate in-office setting.
-Employee regularly is required to sit at desk for long periods of time, use hands/fingers, handle, reach with hand and arms ad talk and hear. Employee occasionally required standing and walking. Regularly lift or move up to 10 pounds. Specific vision ability required includes close vision, and the ability to adjust focus.

Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Signatures

This job description has been approved by all levels of management.

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Manager Date

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HR Date


Employee signature below constitutes employee’s understanding of the requirements, essential functions and duties of the position.


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Employee Date

UR COORDINATOR - NURSING PRECERTIFICATION/AUTHORIZATION