At Blue Mountain Hospital, we are committed to a culture of excellence, empowerment, accountability, and affirmative communication.
Job Description: Utilization Review/Clinical Care Coordinator Assistant
Location: Blue Mountain Hospital
Reports To: Clinical Care Coordinator and Chief Nursing Officer
Position Type: Full-Time
Job Summary
The Utilization Review Assistant plays a crucial support role within the Utilization Review and Clinical Care Coordination Department. This position is responsible for performing essential administrative and communication tasks that facilitate efficient patient care coordination, ensure compliance with payer requirements, and support effective discharge planning. The Utilization Review Assistant acts as a key liaison between the clinical team, patients, and external entities (e.g., insurance companies, post-acute care providers). This position is on-site only and is not eligible for remote work.
Insurance Notifications & Authorization Support:
Initiate and track timely insurance notifications for all inpatient admissions, including initial and concurrent reviews, as directed by the Clinical Care Coordinator or Utilization Review Nurse.
Assist in gathering necessary clinical documentation to support authorization requests and appeals.
Document all communication with insurance companies accurately and thoroughly in the patient's medical record or designated system.
Registration Corrections:
Collaborate with Registration, Patient Access, and Health Information Management (HIM) departments to identify and correct patient registration errors that impact billing, insurance, or care coordination.
Ensure patient demographic and insurance information is accurate and up-to-date in the hospital's electronic health record (EHR) system.
Post-Discharge Follow-Up Calls:
Conduct follow-up telephone calls to all discharged patients from the Emergency Room (ER), Medical-Surgical (Med Surg) units, and Obstetrics (OB) to assess their well-being, address any immediate post-discharge concerns, and ensure continuity of care.
Document outcomes of follow-up calls and escalate any patient issues or concerns to the appropriate clinical staff (e.g., Clinical Care Coordinator, nursing supervisor) for intervention.
Medicare Forms Management:
Responsible for obtaining, preparing, and ensuring timely delivery of required Medicare notices to beneficiaries, including the Medicare Outpatient Observation Notice (MOON) and Important Message from Medicare (IMM).
Educate patients and families on the purpose and implications of these forms, as appropriate and under the guidance of clinical staff.
Obtain necessary patient/representative signatures and ensure proper documentation and distribution of all Medicare forms.
Discharge Planning Assistance:
Provide administrative support to the Clinical Care Coordinator in coordinating patient discharge needs.
Assist with arranging post-acute care services, including scheduling appointments, ordering DME, coordinating transportation, and confirming acceptance with skilled nursing facilities, home health agencies, or other community resources.
Schedule follow-up appointments for discharging patients with their primary care providers or specialists as directed.
Prepare and organize discharge packets for patients, ensuring all necessary instructions, prescriptions, and follow-up appointments are included.
Distribute patient Health Packets to all Med Surg and OB patients and ensure completion of patient information forms within the packets.
Maintain organized records of discharge plans and referrals.
Communication and Collaboration:
Maintain effective communication with patients, families, clinical staff, physicians, and external agencies.
Participate in interdisciplinary team meetings as required.
Adhere to all hospital policies, procedures, and regulatory requirements, including HIPAA and patient confidentiality.
Qualifications
Education: High school diploma or equivalent required. Previous Medical Office or Hospital experience preferred. Associate's degree in healthcare administration, medical office management, or a related field preferred.
Experience: Minimum of 1-2 years of experience in a healthcare setting, preferably in a hospital, clinic, or insurance environment preferred. Experience with utilization review, case management, or patient registration processes is highly desirable.
Skills:
Excellent verbal and written communication skills.
Strong organizational skills and attention to detail.
Proficiency in using electronic health record (EHR) systems and Microsoft Office Suite (Word, Excel, Outlook).
Ability to work independently with minimal supervision and as part of a team.
Strong problem-solving abilities and critical thinking skills.
Demonstrated ability to handle sensitive information with confidentiality and professionalism.
Knowledge of medical terminology and basic understanding of insurance processes (Medicare, Medicaid, commercial).
Ability to sit for extended periods.
Ability to use a computer and phone extensively.
Occasional walking, standing, bending, and reaching.
Ability to lift up to 10 pounds occasionally.
This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the job.
Culture Statement:
At Blue Mountain Hospital, we are committed to a culture of excellence, empowerment, accountability, and affirmative communication.
Value Statement:
Blue Mountain Hospital strives to exemplify values of Excellence, Integrity, Respect, Cultural Sensitivity, Compassion, Accountability, Stewardship and Collaboration.
Vision Statement:
Blue Mountain Hospital vision is to be the standard for rural hospitals.
Mission Statement:
Blue Mountain Hospital is committed to providing an atmosphere of excellence in healing, quality physician care and inspired employees.