Utilization Review Technician 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 Technician 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 Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
JOB SUMMARY
Under the supervision of the VP of Patient Care Services/Chief Nursing Officer and directly reporting to the Director of Care Coordination, the UR Case Manager will work collaboratively with other members of the healthcare team. The case manager also acts as an advocate for the patient and assists in providing information regarding their insurance coverage.
The UR Nurse Case Manager conducts medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed in a nursing unit, including inpatient admissions, patients receiving observation services, and outpatients in a bed. Identifies delays in care. Documents and communicates findings with the care team and the payor, when necessary.
JOB REQUIREMENTS
EDUCATION
EXPERIENCE
OTHER SKILLS REQUIRED
Covenant Health Mission Statement
We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities.
Our Core Values:
We show respect, caring, and sensitivity towards all, honoring the dignity of each person, especially the poor, vulnerable, and suffering.
We promote justice and ethical behavior and responsibly steward our human, financial, and environmental resources.
We work in partnership, dialogue, and shared purpose to create healthy communities.
We deliver all services with the highest level of quality while seeking creative innovation.
Applicants, employees and former employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age (40 or older), disability, and genetic information (including family medical history).