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)
Position Summary:
The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors.
Education:
Holds a current Texas license as a Registered Nurse.
Training and Experience:
Three years clinical nursing experience in general medical/surgical setting or appropriate specialty area; at least one year in an acute care setting.
Job Knowledge:
Excellent verbal and written skills well rounded critical thinking skills, self-motivated, flexible, and goal oriented. Ability to tolerate frequent interruptions and demanding workload
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