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)
Utilization Review Assistant
- (LON012262)The Utilization Review Assistant assures timely and accurate follow through of all office based systems needed to assist with the Utilization Management Department functions. The Utilization Review Assistant collaborates with the case managers and social workers to provide needed documentation and support for day to day Department needs. Fiscal responsibilities include functions to assure positive accounts receivable trends by processing and obtaining information required for authorizations. The Utilization Review Assistant receives supervision and direction from an assigned lead Resource Management Assistant for day to day activities.
1. Appropriate chart documents are chosen and transmitted per decision trees and standard work.
2. Chart documentation is transmitted per department timeliness requirements.
3. Documentation in the billing system of activities and authorizations is complete and timely.
4. Duties performed meet department productivity requirements.
5. Performs other duties as assigned.
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