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)
SUMMARY
The Nurse Case Manager collaborates with other members of the case management and health care teams, utilizes professional nursing skills to: assist the patient in achieving optimal health; assure appropriate use of health care resources; facilitate/coordinate timely care along the continuum; decrease unnecessary variances in care through proactive case management; develop a safe and timely discharge plan to meet the patient’s needs.
QUALIFICATIONS
Equal Opportunity Employer-Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.