Utilization Review/Management Coordinator

Wellington Regional Medical Center

Utilization Review Coordinator

The Utilization Review Coordinator is dedicated to gather and coordinating information regarding patient symptomatology and treatment modalities for the purpose of internal and concurrent reviews with insurance companies. Essential Job Functions and Responsibilities include negotiating and advocating on behalf of the patient and the Hospital, assessing and interpreting the most appropriate level of care based upon patient present level of functioning and responsiveness to treatment interventions, reviewing discharges, completing continued stay reviews with external review agencies, completing pre-certifications, prioritizing daily workload, assisting with denial/appeals, providing Utilization Review guidance consultative services, analyzing patient clinical information to determine patient length of stay and level of care, reviewing all assigned Medicare charts for medical necessity, maintaining Utilization Review files and logs, providing feedback to the Department Manager, attending treatment team daily, completing and updating MIDAS reports, and assuming Hospital Safety Responsibilities.

Minimum Skills, Experience, Licensure and Educational Requirements include RN/MA/MSW, professional licensure in the State of Michigan, experience working with psychiatric utilization review criteria, and knowledge of psychiatric program delivery and utilization review criteria.

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Vacancy posted 3 days ago

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