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)
We are seeking a skilled Utilization Review Nurse and Swing Bed Coordinator to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring the appropriate utilization of healthcare services and resources. Your expertise will contribute to the overall quality of patient care and help optimize healthcare outcomes.
- Conduct comprehensive reviews of medical records to evaluate the medical necessity, appropriateness, and efficiency of healthcare services
- Collaborate with healthcare providers to gather necessary information for utilization review
- Analyze clinical documentation to ensure accurate representation of patient care and support appropriate reimbursement
- Apply knowledge of managed care principles and guidelines to determine the most appropriate level of care for patients
- Participate in discharge planning activities to facilitate safe transitions of care
- Monitor compliance with regulatory requirements.
- Collaborate with interdisciplinary teams to develop and implement strategies for clinical documentation improvement
- Stay updated on industry trends, best practices, and changes in regulations related to utilization review and medical management
- Valid nursing license in Kansas.
- Excellent analytical and critical thinking skills
- Strong attention to detail and ability to prioritize tasks effectively
- Effective communication skills, both written and verbal, to collaborate with healthcare providers and interdisciplinary teams
- Ability to adapt to changing priorities and work independently in a fast-paced environment
Job Type: Full-time
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Work Location: In person