Coordinator, Medical/UR Services
York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
The purpose of the job is to process requests for medical treatment in a timely and highly accurate fashion.
ESSENTIAL JOB RESPONSIBILITIES:
- Triage, analyze and process medical treatment requests
- Document various systems of work completed and outcomes of the reviews
- Interface with Ur Nurses/Medical Director and claims teams to staff cases
- The Coordinator, Medical UR Services reports to the Medical Review Unit Manager
- BS / BA or Equivalent Work Experience
- 1 to 3 years
- Highly organized
- Tremendous sense of urgency
- Ability to multi-task
- Knowledge of Medical Terminology
- Knowledge of Utilization Review Regulations
- Knowledge of Claims/Utilization Computer systems
ROUTINE DECISIONS AND FORMAL POLICY SETTING:
Decisions routinely made include:
- Can the request be processed/approved by the medical coordinator
- Does the review need to be escalated to a Utilization Review Nurse
- Can the review be conducted based upon statutory guidelines
No formal responsibility. Policies associated with the jobs purpose and essential responsibilities are set by others.