RN Utilization Review Coordinator
About The Position
The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Schedule: Monday - Friday, 8am - 4pm CST
Requirements
- Associate degree in nursing/patient care required
- Registered Nurse (RN - Indiana AND Illinois licensure) required
- 3 years of nursing/patient care experience required
Nice To Haves
- Bachelor's Degree in nursing/patient care preferred
- 2 years of Utilization or Case Management experience preferred
Responsibilities
- Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes.
- Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay.
- Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients.
- Provide Physician, Patient, Family, Staff and Student education.
- Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues.
- Perform admission necessity screening using criteria as established by the various federal, state and private sector programs.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Hospitals
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
