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. This role involves performing concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes. The coordinator will 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. They will 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. Additionally, the role includes providing education to physicians, patients, families, staff, and students, and acting as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues. The coordinator will perform admission necessity screening using criteria as established by the various federal, state and private sector programs.
Requirements
- Associate degree in nursing/patient care required
- Registered Nurse (RN - Indiana 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.
Benefits
- Comprehensive benefit offerings
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
