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)
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The Utilization Management Coordinator coordinates and monitors daily activities of the utilization management functions of the Care Coordination Department, ensuring the appropriate allocation of hospital resources while maintaining quality of patient care. This position also holds the responsibility for ensuring regulatory compliance requirements and coordinating the medical management aspects of clinical review requests from external entities. The Utilization Management Coordinator serves as a functional expert and liaison to Care Coordinator Staff and other departments within the hospital system. The UM Coordinator assists to develop consistent processes and enhance workflow of the concurrent review process with third party payers. The UM Coordinator oversees and facilitates medical necessity appeals as the result of concurrent denials. The UM Coordinator functions as the PRO Liaison facilitating the review process for Hospital Issued Notices of Non-Coverage (HINN's) and discharge reviews as they relate to Care Coordinator activities and directing PRO correspondence and cost outliers to the appropriate internal department. Provides Care Coordination Support as needed.
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