Utilization & Authorization Review Coordinator - Rehab Memorial Health System of Southwest Oklahoma - 2.0 Lawton, OK Job Details Full-time 14 hours ago Qualifications High school diploma or GED Utilization management Resource utilization in healthcare Full Job Description Job Brief Full time Memorial Health System of Southwest Oklahoma - Gore Blvd. Lawton, OK 73505

Compensation:

Based on Experience

DEFINITION

All duties and criteria-based standards within this document will be performed according to established policies, procedures, and guidelines within the department and hospital. The Utilization & Authorization Review Coordinator is responsible for managing the end-to-end authorization process and ensuring the medical necessity of outpatient physical , occupational and speech therapies. This role acts as a bridge between the clinical therapy team, patients, and insurances to secure approvals, prevent claim denials, and optimize the delivery of care within plan guidelines. Reviews patient records for documentation of Intensity of Service and Severity of Illness and compares against established criteria. Assists the medical staff with potential denials and interacts to complete the review process. Completes insurance company clinical review updates. Obtains authorization and current plan of care documents for outpatient therapies.

EDUCATION

High school diploma. College degree preferred.

LICENSURE/CERTIFICATION/REQUIREMENTS

This role can be administrative, however, a clinical licensure is preferred. Must have 2+ years experience in healthcare utilization management. Must have computer competency.

PREFERRED QUALIFICATIONS

Clinical Degree Experience w/ Medical coding (ICD, CPT) and payor web portals Experience in an outpatient therapy clinical setting. Prior medical record background, plus prior experience in utilization review are preferred.