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)
Gentiva is an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may make the most of every moment. We believe that better care for caregivers and clinicians means better care for everyone, so we offer ongoing professional training, lower nurse-to-patient ratios, and comprehensive benefits for eligible employees. Here, you’ll join gifted colleagues who make a lasting difference in people’s lives every day.
The Utilization Manager plans, coordinates, implements, and finalizes projects according to the specifications, deadlines, and budget. The role manages the daily, weekly, and monthly metrics, processes, and reporting for medical supplies, durable medical equipment, and pharmacy utilization. This role also works closely with branch personnel to identify and deploy best practice utilization processes. This role will work with PPO vendors to ensure service levels are at or above expectations and when less deploy corrective action plans for improvement in conjunction with the vendor. The individual must be able to travel 50% of the time.
At least 2 years of experience planning, leading, and directing complex initiatives
Healthcare/Clinical Experience preferred
At least 5 years of experience planning, leading, and directing complex initiatives
Healthcare/Clinical Experience preferred
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