Utilization Management Coordinator

Corewell Health • Southfield, MI

2d • Onsite

About The Position

This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.

Requirements

• Associate's Degree or technical degree.
• 2 years of experience in a clinical/hospital setting.
• LIC-Registered Nurse (RN) - State of Michigan Upon Hire required

Nice To Haves

• Bachelor's Degree in nursing or related field.
• Hospital utilization review/utilization management experience.
• Clinical appeals experience.

Responsibilities

• Accountability for utilization review (UR), including admission, concurrent, and retrospective reviews.
• Coordinate activities involved in the certification, recertification, and concurrent appeals process.
• Conduct referrals for 2nd level review, as needed.
• Ensure timely communication with payers based on adequate and complete documentation.
• Initiate concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: Associate degree