Utilization Review Coordinator

The Utilization Review Coordinator performs admission screening for patients to assess medical necessity and reviews for appropriateness of setting and utilization.

Location: Work From Home, Indiana 46544

Salary: $56,971.20–$84,749.60/yr

Responsibilities

• Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes.
• Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay.
• Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients.
• Provide Physician, Patient, Family, Staff and Student education.
• Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues.
• Perform admission necessity screening using criteria as established by the various federal, state and private sector programs.

Requirements

• Associate degree in nursing/patient care
• Registered Nurse (RN - Indiana licensure)
• 3 years of nursing/patient care experience

Benefits

• Comprehensive benefit offerings

Additional Information

• Schedule: Monday - Friday, 8am - 4:30pm EST.
• Travel is required: Never or Rarely.