Utilization Review Coordinator jobs in Anderson, SC
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)
Recently Added Utilization Review Coordinator jobs
- Prisma Health
-
Greenville, SC
FULL_TIME
-
Inspire health. Serve with compassion. Be the difference.
Job Summary
The RN - Quality Review is responsible for promoting a Culture of Safety through the coordination, evaluation, and implementation of processes that improve the quality and safety of care delivered by Physicians and Advanced Practice Providers throughout the system. Working directly with Medical Staff senior leadership, and in collaboration with patient safety, quality, risk management, and legal departments, the RN-Quality Review is responsible for receiving and reviewing safety events related to Medical Staff Members and Advanced Practice Providers. The RN-Quality Review develops improvement plans for individuals and coordinates peer review committees across the three medical staffs. Other key responsibilities of the RN-Quality Review are:
- Serve as experts regarding accreditation and regulatory requirements.
- Ensure all peer review activities conform to law, regulation, and medical staff bylaws.
- Perform data analysis to identify trends and patterns of unsafe practices by individual and groups.
- Provide ongoing peer review and Professional Practice Evaluation support to department chairs, peer review committees, and MECs.
-Support the Practitioner Health committees throughout the system.
-Work collaboratively with internal and external resources to ensure physicians and advanced practice providers can optimize their health and performance.
- Serve as expert and resource in dealing with bylaws and legal issues pertaining to disciplinary action, and Fair Hearing processes.
-Create reliable systems and processes to elevate the overall safety and quality of care delivered across the system as they relate to the care, treatment, and services provided by medical staff members.
- Utilizes the Just Culture Algorithm and Medical Staff Bylaws to guide the development and implementation of Professional Practice plans.All employees are expected to be knowledgeable and compliant with Prisma Health values of compassion, dignity, excellence, integrity and teamwork. In addition, this job entails staying current with and using clinical knowledge, guidelines, and requirements to very accurately research, review, collect, document, aggregate, organize, reconcile, analyze, interpret, submit, report, present data and/or information by deadlines to appropriate staff and/or into databases. Maintains databases and keeps them current. Assists with identification of improvement opportunities, coordinates, attends and presents at meetings as requested. Performs other work as assigned. This position is primarily in Greenville, SC with the occasional need for travel to Columbia, SC...
Accountabilities* Performs medical record reviews and/or abstraction, using applicable inclusion and exclusion criteria and methodology (sampling, randomization, etc.) to identify patient and/or indicators for review/study, to obtain very accurate, valid, reliable data. Summarizes and presents data as requested.\u00A0
* Uses available databases, medical record and its tools to produce reports and improve data collection efficiency. Also creates databases as needed.\u00A0
* Completes by deadlines website/database data entry, tracking, reconciliation, reporting, submission and transmission of completed data.\u00A0
* Coordinates, attends, and/or documents meeting as designated\u00A0
* Communicates well verbally and in writing with staff\u00A0
* Supports physician quality review\u00A0
* Performs other work as assigned
Supervisory/Management ResponsibilitiesThis is a non-management job that will report to a supervisor, manager, director or executive.Minimum EducationBachelor's Degree - Nursing
Minimum Experience3 years - Inpatient nursing required
Required Certifications/Registrations/LicensesRN - REGISTERED NURSE - NLRNOther Required SkillsProficient with Word, Excel, PowerPoint, etc.
Other Required ExperienceClinical chart review, abstraction, analysis, summarization, management, database data entry; statistical knowledge; quality improvement/patient safety knowledge and experience - Preferred
Work Shift
Day (United States of America)Location
Greenville Memorial Med CampusFacility
7001 CorporateDepartment
70019507 Professional PracticeShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Job Summary
The RN - Quality Review is responsible for promoting a Culture of Safety through the coordination, evaluation, and implementation of processes that improve the quality and safety of care delivered by Physicians and Advanced Practice Providers throughout the system. Working directly with Medical Staff senior leadership, and in collaboration with patient safety, quality, risk management, and legal departments, the RN-Quality Review is responsible for receiving and reviewing safety events related to Medical Staff Members and Advanced Practice Providers. The RN-Quality Review develops improvement plans for individuals and coordinates peer review committees across the three medical staffs. Other key responsibilities of the RN-Quality Review are:
- Serve as experts regarding accreditation and regulatory requirements.
- Ensure all peer review activities conform to law, regulation, and medical staff bylaws.
- Perform data analysis to identify trends and patterns of unsafe practices by individual and groups.
- Provide ongoing peer review and Professional Practice Evaluation support to department chairs, peer review committees, and MECs.
-Support the Practitioner Health committees throughout the system.
-Work collaboratively with internal and external resources to ensure physicians and advanced practice providers can optimize their health and performance.
- Serve as expert and resource in dealing with bylaws and legal issues pertaining to disciplinary action, and Fair Hearing processes.
-Create reliable systems and processes to elevate the overall safety and quality of care delivered across the system as they relate to the care, treatment, and services provided by medical staff members.
- Utilizes the Just Culture Algorithm and Medical Staff Bylaws to guide the development and implementation of Professional Practice plans.All employees are expected to be knowledgeable and compliant with Prisma Health values of compassion, dignity, excellence, integrity and teamwork. In addition, this job entails staying current with and using clinical knowledge, guidelines, and requirements to very accurately research, review, collect, document, aggregate, organize, reconcile, analyze, interpret, submit, report, present data and/or information by deadlines to appropriate staff and/or into databases. Maintains databases and keeps them current. Assists with identification of improvement opportunities, coordinates, attends and presents at meetings as requested. Performs other work as assigned. This position is primarily in Greenville, SC with the occasional need for travel to Columbia, SC...
Accountabilities* Performs medical record reviews and/or abstraction, using applicable inclusion and exclusion criteria and methodology (sampling, randomization, etc.) to identify patient and/or indicators for review/study, to obtain very accurate, valid, reliable data. Summarizes and presents data as requested.\u00A0
* Uses available databases, medical record and its tools to produce reports and improve data collection efficiency. Also creates databases as needed.\u00A0
* Completes by deadlines website/database data entry, tracking, reconciliation, reporting, submission and transmission of completed data.\u00A0
* Coordinates, attends, and/or documents meeting as designated\u00A0
* Communicates well verbally and in writing with staff\u00A0
* Supports physician quality review\u00A0
* Performs other work as assigned
Supervisory/Management ResponsibilitiesThis is a non-management job that will report to a supervisor, manager, director or executive.Minimum EducationBachelor's Degree - Nursing
Minimum Experience3 years - Inpatient nursing required
Required Certifications/Registrations/LicensesRN - REGISTERED NURSE - NLRNOther Required SkillsProficient with Word, Excel, PowerPoint, etc.
Other Required ExperienceClinical chart review, abstraction, analysis, summarization, management, database data entry; statistical knowledge; quality improvement/patient safety knowledge and experience - Preferred
Work Shift
Day (United States of America)Location
Greenville Memorial Med CampusFacility
7001 CorporateDepartment
70019507 Professional PracticeShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
- 19 Days Ago
- Cedar Creek Management Services
-
Cashiers, NC
FULL_TIME
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- 20 Days Ago
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-
Charleston, SC
FULL_TIME
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- 11 Days Ago
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0 Utilization Review Coordinator jobs found in Anderson, SC area
- Kelly Services
-
Greer, SC
- Job Description Job Description Feeling stuck? Put your career in motion with a great, new opportunity. Join the Kelly® ...
- 4/18/2024 12:00:00 AM
- East Carolina University
-
Greenville, SC
- Job Title Administrative Support Specialist Position Number 921716 Vacancy Open to All Candidates Time-Limited No Depart...
- 4/18/2024 12:00:00 AM
- East Carolina University
-
Greenville, SC
- Job Title Administrative Support Associate-Advanced Position Number 937429 Vacancy Open to All Candidates Time-Limited N...
- 4/18/2024 12:00:00 AM
- Advanceautoparts
-
Anderson, SC
- Location: Retail Parts Pro in Anderson, SC at Advance Auto Parts **Career Description** **Retail Parts Pro** At **Advanc...
- 4/17/2024 12:00:00 AM
- Kodiak Labor Solutions, LLC
-
Greenville, SC
- Kodiak Labor Solutions is currently hiring a tenured Administrative Assistant with consistent and recent experience as a...
- 4/14/2024 12:00:00 AM
- NVR Inc
-
Lavonia, GA
- NVR, Inc., Parent Company of Ryan, NV, and Heartland Homes has been helping families build their happily ever after sinc...
- 4/14/2024 12:00:00 AM
- Walmart
-
Anderson, SC
- **Job Summary:** As a Material Handler at Walmart, you will be responsible for efficiently managing the flow of material...
- 4/14/2024 12:00:00 AM
- Healthcare Services Group, Inc.
-
ANDERSON, SC
- Overview: Who We Are Healthcare Services Group (HCSG) is an experienced partner managing housekeeping, laundry, dining, ...
- 4/3/2024 12:00:00 AM
About Anderson, South Carolina
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