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 DESCRIPTION
Under the direction of the Director of Care Coordination and Patient Trasnitions, the Lead Care Coordinator- Utilization Review is responsible for completing all performance indicators listed under the Utilization Review Nurse job description. In addition, the Lead Care Coordinator has additional leadership, administrative duties. The Lead Care Coordinator steps in to lead the department with the leads in Medsurge and ED/IPP when the Director is out.
EDUCATION
Must meet one of the following requirements: Current RN license to practice professional nursing in the State of Vermont.
EXPERIENCE
Minimum of two or more years of progressive clinical experience. Some management/supervisory experience preferred.