Utilization Management Coordinator

Utilization Review Role

Scope of Work: This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.

Qualifications:

• Required Associate's Degree Associates or technical degree.
• Preferred Bachelor's Degree in nursing or related field.
• 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required
• Hospital utilization review/utilization management experience. Preferred
• Clinical appeals experience. Preferred
• LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire required

Physical Demands:

• Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 50 lbs
• Waist to Waist > 5 lbs: Seldom up to 50 lbs
• Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
• Waist to Overhead > 5 lbs: Seldom up to 5 lbs
• Bilateral Carry > 5 lbs: Seldom up to 25 lbs
• Unilateral Carry > 5 lbs: Seldom up to 10 lbs
• Pushing Force > 5 lbs: Occasionally up to 25 lbs
• Pulling Force > 5 lbs: Occasionally up to 20 lbs
• Sitting: Occasionally
• Standing: Frequently
• Walking: Frequently
• Forward Bend - Standing: Occasionally
• Forward Bend - Sitting: Occasionally
• Trunk Rotation - Standing: Occasionally
• Trunk Rotation - Sitting: Occasionally
• Squat: Seldom
• Stair Climbing: Seldom
• Crawling / Kneeling: Seldom
• Reach - Above Shoulder: Occasionally
• Reach - at Shoulder or Below: Occasionally
• Handling: Occasionally
• Forceful Grip > 5 lbs: Occasionally
• Forceful Pinch > 2 lbs: Occasionally
• Finger/Hand Dexterity: Frequently
• Visual Acuity ¹ [None = No; Seldom = Yes]: Seldom
• Color Vision (Ishihara) Test [None = No; Seldom = Yes]: Seldom

How Corewell Health Cares For You

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd

Department Name

Utilization Management - Diversified East WB Mkt

Employment Type

Part time

Shift

Day (United States of America)

Weekly Scheduled Hours

20

Hours of Work

8AM-4:30PM

Days Worked

2-3 days per work week

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

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