What is a Pre-Service Coordinator?

"What do you do?" is often the next question I am asked after I tell people I am nonclinical. Prior to 2021, if you asked me what a Pre-Service Coordinator does, I would just be guessing. My guess would likely not involve a therapist doing the job. When working in home health, I heard the title "Utilization Review," but I would have defined that as the person who sends e-mails asking, "how can we decrease the number of visits (due to PDGM)?"

Utilization Review: what is it and why do we need it?

Utilization Review (UR) is an umbrella term to mean a role where someone is trying to determine quality and cost of healthcare services. Unfortunately, we know that healthcare in the United States has many flaws, and much money gets wasted. In 2019, JAMA published a literature review of United States healthcare spending and concluded that waste ranges $760 billion to $935 billion annually.

What does a Pre-Service Coordinator do?

Pre-Service Coordinator (PSC) is a role under the umbrella of Utilization Review. A broad 1 sentence definition would be:

The PSC reviews medical charts to synthesize data to help determine an appropriate level of care.

There are 2 groups of PSCs at naviHealth. One group determines whether someone needs to be authorized for admission to a Skilled Nursing Facility (SNF) and the other group for Long Term Acute Care (LTAC) and Inpatient Rehab (IRF/AIR). The teams consistent of Physical Therapists, Occupational Therapists and Nurses. Unfortunately, Speech-Language Pathologists and Assistants are not hired at naviHealth for this role, but there are some companies that do hire for various UR positions.

What does a typical day look like?

I work on the IRF/LTAC team, and I review medical charts for Medicare Advantage members who have IRF authorization requests. A referral primarily comes from a hospital and medical records are attached to the case to be reviewed. The number of pages to scan through varies a lot. If I get everything I need, 15-30 pages can provide all the information. Often times it is 40-80 pages. I think my record so far is >240 pages. If I have the information I need, I write a summary of what has happened, provide a recommendation of whether or not IRF is necessary under Medicare Chapter 1 guidelines, and send the case to the Medical Director to make a determination. If I need more information, I have a process to go through to obtain more updated information before writing up the summary.

Additional common tasks include:

1. reviewing e-mails throughout the day to see what cases need to be prioritized

2. making phone calls to request updated clinicals

3. notifying liaisons/case managers of the need for Peer-to-Peer calls with a physician or advanced healthcare practitioner

4. calling liaisons about denials and providing the member's option to appeal the denial

5. reviewing requests for more days in the rehab

6. answering calls throughout the United States primarily asking questions regarding authorization status

7. asking lots of questions to co-workers through Microsoft Teams who have been in the job longer than I have

Where do I work?

At naviHealth, PSCs work 100% remote, so I work entirely at home. A major benefit is that the job is not restricted to one region of the country.

Who would enjoy this type of job?

Someone who wants a consistent work schedule, can work on their own, enjoys reading through a variety of medical cases, has good customer service skills, likes systematic processes, and doesn't get frustrated with multi-tasking.

Who would enjoy this type of job?

Someone who needs to physically be around people, has difficulty switching between tasks, dislikes talking on the phone, and prefers not to read through medical records.

Interested in going nonclinical? The 1st step is to make a nonclinical resume.

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