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)
Job Summary :
Performs utilization review with external agencies to ensure payment for medically necessary inpatient services.
Essential Functions :
Minimum Qualifications : Bachelor’s degree or commensurate experience in a related field of Psychology or Utilization Review.
Completion of Handle with Care Basic Certification in physical and nonverbal patient management within two months of hire with annual re-certification.
Knowledge, Skills & Abilities : Master’s degree in Psychology, preferred. Previous experience with utilization review, case management or telephone triage desired.
Familiarity with electronic medical records and medical terminology.
Physical Requirements : Constantly sit, see / visual acuity, handle / grasp / feel, talk / hear, lift / carry 1 to 25 lbs.
Frequently stand, walk, reach, bend / twist, lift / carry 25 to 49 lbs. Occasionally lift / carry 50 lbs.
Last updated : 2024-03-23
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