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Universal Health Services

Job Code:
Universal Health Services
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Job Details

Deltek Talent Management - UR COORDINATOR - (13202)

Job Details


Facility Name
FHCHS of PR, Inc.
Career Area
Job Description


The Utilization Review Coordinator is responsible for all case management tasks in the different levels of care and for making sure that all clients receives the best services available:

  1. Visits the hospital facilities or receives the documentation via fax and carries out the audit of the file or the clinical information.
  2. Discuss the cases with the psychiatrists, psychologists, or social worker for the care authorizations.
  3. Maintains the daily census of the assigned facilities.
  4. Responsible for making sure that the physician to physician analysis takes place.
  5. Authorizes all the inpatient or partial hospitalizations.
  6. Issues the services authorizations after the audit is finished.
  7. Maintains updated in the system the cases’ utilization review documentation.
  8. Maintains a log and reports in the system the ineligible cases.
  9. Provides the monthly utilization data of the facilities assigned.
  10. Maintains the cases registry updated by facility and account.
  11. Participates in the consul’s meetings.
  12. Keeps the specialization license and professional association membership (colegiación) effective.
  13. Available to travel throughout Puerto Rico.
  14. Conduct prospective, current, retrospective review and discharge planning.
  15. Responsible to evaluate the quality, retrospective review and discharge planning.
  16. Responsible to evaluate the quality, medical necessity and services provided.
  17. Other duties related to the utilization management process.
  18. Knows the theoretical and practical principles inherent to the position.



Job Requirements

::Minimum qualifications:

       - Education: Masters in Social Work, Psychology, Psychological Counseling, Mental Health Counseling, Psychiatric Nursing, or BSN

       - Licenses: Valid and current active license for Social Work, Psychiatric Nursing, BSN, Psychological Counseling, Psychology, or Mental Health Counseling

       - Professional associating membership (colegiación): Valid membership for Social Work and Psychiatric Nursing

       - Relevant Work Experience: Two or more years of experience in the health field


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