Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Applicants must live in Volusia or Flagler Counties to be Considered.
UM department functions 7 days/wk, 365 days/year with a 24/7 on-call nurse. Weekend/holiday rotations and on-call rotations may be required. We currently have nurses working about once every 6-8 weekends.
POSITION SUMMARY:
Under the direction and oversight of the Nurse Supervisor Utilization Management, the Inpatient Utilization Review Nurse is responsible for coordination of services for members of Florida Healthcare Plans admitted to and/or discharged from an inpatient acute or skilled nursing facility as well as outpatient services as delegated. The Inpatient Utilization Review Nurse coordinates all systems/services needed for an organized, multidisciplinary, member focused team approach. The Inpatient Utilization Review Nurse follows and manages the course of treatment for patients while coordinating care with physicians, nurses, case managers, and other staff from outside as well as within the company to ensure quality care and safe outcomes. The Inpatient Utilization Review Nurse conducts initial and ongoing assessments and ensures continuity of care through discharge planning and utilization of resources. Care should be approached in a cost-effective manner as this position bears risk for financial impact to the organization.
QUALIFICATIONS:
Education, skills, and experience: