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Utilization Review Intake Coordinator Jobs in Rhode Island

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Utilization Review Intake Coordinator information

What does a utilization review intake coordinator do?

A Utilization Review Intake Coordinator is responsible for reviewing and processing incoming referrals and requests for healthcare services to ensure they meet clinical guidelines and payer requirements. They collect and verify patient information, coordinate with healthcare providers, and initiate case reviews for medical necessity and insurance authorization. Their work is vital in ensuring patients receive appropriate care while adhering to insurance and regulatory policies.

What are the key skills and qualifications needed to thrive as a utilization review intake coordinator?

To thrive as a Utilization Review Intake Coordinator, you need a solid understanding of medical terminology, insurance processes, and healthcare regulations, often supported by a background in healthcare administration or nursing. Familiarity with electronic medical records (EMR) systems, insurance verification tools, and authorization management software is typically required. Strong organizational skills, attention to detail, and effective communication are essential soft skills for this position. These competencies ensure accurate and timely processing of patient cases, compliance with regulations, and coordination among patients, providers, and payers.

What are some common challenges faced by utilization review intake coordinators, and how can they be managed?

Utilization Review Intake Coordinators often face the challenge of managing high volumes of case referrals while ensuring accuracy and timeliness in processing. Balancing multiple priorities, such as coordinating with clinical staff, verifying insurance information, and meeting regulatory deadlines, can be demanding. Effective time management, strong communication skills, and familiarity with electronic health record (EHR) systems are essential for handling these challenges. Staying organized and building strong working relationships with both internal teams and external stakeholders also helps streamline workflows and reduce stress.

What is the difference between Utilization Review Intake Coordinator vs Utilization Review Nurse?

AspectUtilization Review Intake CoordinatorUtilization Review Nurse
CredentialsHigh school diploma or equivalent; certification may be preferredRN license; certification in case management or utilization review often required
Work EnvironmentOffice setting, administrative tasks, patient data intakeClinical setting, reviewing medical records, patient care coordination
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsHospitals, clinics, insurance companies
Search & Comparison IntentFocus on administrative and intake responsibilitiesFocus on clinical review and patient care decisions

The Utilization Review Intake Coordinator primarily handles administrative tasks related to patient data intake and initial review, often requiring administrative credentials. In contrast, the Utilization Review Nurse performs clinical assessments, reviews medical records, and makes patient care decisions, requiring an RN license. Both roles are essential in healthcare utilization management but differ in their focus and qualifications.

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What cities in Rhode Island are hiring for Utilization Review Intake Coordinator jobs?

Cities in Rhode Island with the most Utilization Review Intake Coordinator job openings:

Utilization Review Intake Coordinator jobs near you

Behavioral Health Intake and Utilization Review Coordinator

CharterCARE of Rhode Island

Providence, RI • On-site

Full-time

Re-posted 13 days ago

Job description

Summary: The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating admissions, and overseeing utilization review activities to ensure timely access to care and appropriate resource utilization. This role is actively involved with communicating with other community hospitals and Emergency Departments and will also facilitate outside admissions to our services to maximize hospital census. This role ensures adherence to regulatory and payer requirements while serving as a key liaison between patients, providers, and insurance carriers.
Education: Bachelor's degree Nursing required. Master's degree preferred.
Experience: Minimum 2-3 years of experience in behavioral health, preferably in intake or utilization review roles.
License: RI RN License required.
Skills and Qualifications:
  • Strong clinical assessment and diagnostic skills.
  • Working knowledge of behavioral health levels of care and medical necessity criteria (e.g., MCG, InterQual).
  • Familiarity with insurance authorization processes and managed care systems.
  • Excellent organizational, communication, and interpersonal skills.
  • Proficiency in EHR and Microsoft Office Suite.

Working Conditions, Physical Environment and/or Safety Requirements: Lifting up to 30 lbs. and occasionally lifting and/or carrying such articles as files, books, etc. Involves sitting, walking, stooping, and reaching. However, as necessary, must be able to meet the physical requirements for staff level positions in the department(s).

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