Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility. Responsibilities ESSENTIAL FUNCTIONS: * Act as liaison between managed care organizations and the ...
Service Coordinator
Juncos, PR · On-site
$19.25 - $24.25/hr
... space utilization tracking * Update workplace systems and databases related to occupancy ... Strong organizational and coordination skills * Ability to manage multiple requests and priorities ...
Service Coordinator
Juncos, PR · On-site
$19.25 - $24.25/hr
... space utilization tracking * Update workplace systems and databases related to occupancy ... Strong organizational and coordination skills * Ability to manage multiple requests and priorities ...
Service Coordinator
Juncos, PR · On-site
$19.25 - $24.25/hr
... space utilization tracking * Update workplace systems and databases related to occupancy ... Strong organizational and coordination skills * Ability to manage multiple requests and priorities ...
Service Coordinator
Juncos, PR · On-site
$19.25 - $24.25/hr
... space utilization tracking * Update workplace systems and databases related to occupancy ... Strong organizational and coordination skills * Ability to manage multiple requests and priorities ...
$12.75 - $16.50/hr
... utilization Planning: Determine proper stocking levels and set Min/Max and safety stocks ... Coordination: Coordinate with external partners and other departments, such as marketing, finance ...
$12.75 - $16.50/hr
... utilization Planning: Determine proper stocking levels and set Min/Max and safety stocks ... Coordination: Coordinate with external partners and other departments, such as marketing, finance ...
PR · On-site
The Workforce Management/RTA Coordinator plays a key role in improving workforce planning, administration, and the efficient utilization of employees within an organization. The primary goal of this ...
Quick apply
PR · On-site
The Workforce Management/RTA Coordinator plays a key role in improving workforce planning, administration, and the efficient utilization of employees within an organization. The primary goal of this ...
Quick apply
PR · On-site
The Workforce Management/RTA Coordinator plays a key role in improving workforce planning, administration, and the efficient utilization of employees within an organization. The primary goal of this ...
Quick apply
PR · On-site
The Workforce Management/RTA Coordinator plays a key role in improving workforce planning, administration, and the efficient utilization of employees within an organization. The primary goal of this ...
Quick apply
Customer Success Coach
San Juan, PR · On-site
... utilization among our customers. Also providing support and top-notch customer service experience ... Lead point of contact and coordination for all assignment components - including internal and ...
Customer Success Coach
San Juan, PR · On-site
... utilization among our customers. Also providing support and top-notch customer service experience ... Lead point of contact and coordination for all assignment components - including internal and ...
Process Engineer
Manati, PR · On-site
... utilization of best process. Performs duties encompassing all process transfers and other projects ... Coordinates work in conjunction with personnel assigned to specific projects. Responsibilities:
Process Engineer
Manati, PR · On-site
... utilization of best process. Performs duties encompassing all process transfers and other projects ... Coordinates work in conjunction with personnel assigned to specific projects. Responsibilities:
Process Engineer
Manati, PR · On-site
... utilization of best process. Performs duties encompassing all process transfers and other projects ... Coordinates work in conjunction with personnel assigned to specific projects. Responsibilities:
Process Engineer
Manati, PR · On-site
... utilization of best process. Performs duties encompassing all process transfers and other projects ... Coordinates work in conjunction with personnel assigned to specific projects. Responsibilities:
Lead regional launch execution to drive awareness, demand generation, appropriate utilization, and ... Proven success working within highly matrixed organizations and leading coordinated execution ...
Lead regional launch execution to drive awareness, demand generation, appropriate utilization, and ... Proven success working within highly matrixed organizations and leading coordinated execution ...
... coordination of complex construction projects, facility rehabilitation efforts, and program ... Track program budgets, expenditures, and resource utilization * Monitor cost performance and ...
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... coordination of complex construction projects, facility rehabilitation efforts, and program ... Track program budgets, expenditures, and resource utilization * Monitor cost performance and ...
Capital Projects Director
Gurabo, PR · On-site
$120 - $150/hr
Key Responsibilities * Serve as the central SPOC for scheduling, resource coordination, and ... Monitor resource performance, utilization, and delivery effectiveness across the portfolio.
Capital Projects Director
Gurabo, PR · On-site
$120 - $150/hr
Key Responsibilities * Serve as the central SPOC for scheduling, resource coordination, and ... Monitor resource performance, utilization, and delivery effectiveness across the portfolio.
Support project teams with documentation tracking, meeting minutes, reporting activities, and project coordination tasks. * Support monitoring of project progress, resource utilization, deliverable ...
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Support project teams with documentation tracking, meeting minutes, reporting activities, and project coordination tasks. * Support monitoring of project progress, resource utilization, deliverable ...
Support project teams with documentation tracking, meeting minutes, reporting activities, and project coordination tasks. * Support monitoring of project progress, resource utilization, deliverable ...
Quick apply
Support project teams with documentation tracking, meeting minutes, reporting activities, and project coordination tasks. * Support monitoring of project progress, resource utilization, deliverable ...
Support project teams with documentation tracking, meeting minutes, reporting activities, and project coordination tasks. * Support monitoring of project progress, resource utilization, deliverable ...
Quick apply
Support project teams with documentation tracking, meeting minutes, reporting activities, and project coordination tasks. * Support monitoring of project progress, resource utilization, deliverable ...
Works closely with the Referral Coordinator (RC) in the utilization of available staff and resources with the goal of providing the highest level of support and customer service to referring ...
Works closely with the Referral Coordinator (RC) in the utilization of available staff and resources with the goal of providing the highest level of support and customer service to referring ...
Program Manager
Caguas, PR · On-site
$125K/yr
... utilization, operational risks, and program outcomes; identifying issues and developing ... Experience planning, coordinating, monitoring, and evaluating multiple projects or organizational ...
Program Manager
Caguas, PR · On-site
$125K/yr
... utilization, operational risks, and program outcomes; identifying issues and developing ... Experience planning, coordinating, monitoring, and evaluating multiple projects or organizational ...
Program Manager
Mayaguez, PR · On-site
$125K/yr
... utilization, operational risks, and program outcomes; identifying issues and developing ... Experience planning, coordinating, monitoring, and evaluating multiple projects or organizational ...
Program Manager
Mayaguez, PR · On-site
$125K/yr
... utilization, operational risks, and program outcomes; identifying issues and developing ... Experience planning, coordinating, monitoring, and evaluating multiple projects or organizational ...
Utilization Coordinator information
What is a utilization coordinator?
Utilization Coordinators are healthcare professionals responsible for reviewing and monitoring the use of medical services to ensure patients receive appropriate care efficiently and cost-effectively. They assess treatment plans, review medical records, and help coordinate care among providers to ensure compliance with insurance and regulatory guidelines. Utilization Coordinators also work with clinical staff to determine the medical necessity of procedures and help optimize patient outcomes while managing healthcare costs.
How does a utilization coordinator typically interact with clinical and administrative teams in a healthcare setting?
A Utilization Coordinator regularly collaborates with both clinical teams, such as physicians and nurses, and administrative staff to ensure that patient care services are medically necessary and efficiently delivered. They review medical records, coordinate pre-authorizations, and communicate with insurance providers to support appropriate resource use. Effective communication and teamwork are essential, as Utilization Coordinators often serve as a liaison between departments, helping to resolve discrepancies and streamline processes for optimal patient outcomes.
What are the key skills and qualifications needed to thrive as a utilization coordinator, and why are they important?
To thrive as a Utilization Coordinator, you need a background in healthcare or social services, strong analytical skills, and familiarity with medical terminology, often supported by a relevant degree or certification. Proficiency in case management software, electronic health records (EHRs), and knowledge of insurance policies and regulatory requirements is typically required. Excellent communication, organizational, and problem-solving abilities help you effectively coordinate care and advocate for patient needs. These skills ensure efficient resource utilization, regulatory compliance, and optimal patient outcomes within healthcare organizations.
What is the difference between Utilization Coordinator vs Utilization Review Specialist?
| Aspect | Utilization Coordinator | Utilization Review Specialist |
|---|---|---|
| Credentials | Typically requires healthcare-related certifications or licenses, such as a Registered Nurse (RN) or healthcare administration background | Often requires similar healthcare credentials, including RN, licensed practical nurse (LPN), or medical reviewer certifications |
| Work Environment | Works in hospitals, clinics, or insurance companies, coordinating patient services and resource allocation | Works mainly in insurance companies or healthcare facilities, reviewing medical necessity and treatment plans |
| Employer & Industry Usage | Commonly employed by healthcare providers and insurance companies to optimize resource use | Primarily employed by insurance companies and third-party payers for case reviews |
While both roles involve healthcare coordination and require similar credentials, the Utilization Coordinator focuses on managing patient services and resource allocation, whereas the Utilization Review Specialist primarily reviews medical necessity and treatment plans for approval or denial.
What degree do I need for utilization review?
Utilization coordinators typically need at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data management tools is also important.
What are popular job titles related to Utilization Coordinator jobs in Puerto Rico?
For Utilization Coordinator jobs in Puerto Rico, the most frequently searched job titles are:
What job categories do people searching Utilization Coordinator jobs in Puerto Rico look for?
The top searched job categories for Utilization Coordinator jobs in Puerto Rico are:
Full-time
Re-posted 3 days ago
Job description
Overview
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ResponsibilitiesESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.
Employment Type: FULL_TIME