UR Coordinator
UHS
Summary
The Utilization Review Coordinator (URC) is responsible for initial clinical review. URC may approve requests for admissions, procedures, and services that meet clinical review criteria, but must refer requests that do not meet clinical review criteria to peer clinical review for certification or non-certification.
Job description
Responsibilities and essential duties
- Visits the hospital facilities or receives the documentation via fax and performs the initial review of the clinical information.
- Discusses the cases with psychiatrists, psychologists, or social workers as appropriate to discuss medical necessity criteria for authorizations.
- Maintains the daily census of the assigned facilities.
- Responsible for making sure that the peer-to-peer discussion takes place.
- Issues the services authorizations after the review is completed.
- Maintains updated utilization review documentation in the platforms.
- Documents and reports in the system the ineligible cases.
- Provides the daily utilization data of the facilities assigned.
- Maintains a registry of all cases by facility/providers and account in the UMP platform.
- Participates in departmental meetings.
- Keeps the specialization license and professional association membership effective.
- Complies with the continuing education hours that correspond to the specialization.
- Participates in mandatory training courses such as the annual compliance plan and updated clinical criteria.
- Informs the supervisor or human resources of any sanction or revocation of the license that affects the practice of the profession.
- Complies with standards of Service Excellence Program.
- Available to travel throughout Puerto Rico.
- Conducts prospective, concurrent, retrospective review and discharge planning.
- Evaluates the quality, medical necessity and services provided.
- Provides guidance to the non-clinical staff as needed.
- Provides written notices to the members and providers via fax, mail and/or secure email.
Requirements
- Professional specialization license
- Active membership in a professional association
- Available to travel throughout Puerto Rico
- Compliance with continuing education hours
- Knowledge of clinical review criteria and medical necessity standards
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.