Utilization Review Technician 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 Technician 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 Technician consults with nurses and physicians as needed. Position is non-RN. May require an associate degree or its equivalent. Typically reports to a supervisor. May require Registered Health Information Technician (RHIT). The Utilization Review Technician gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Utilization Review Technician typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and implementation of a discharge plan for an assigned group of patients. The Case Manager serves as a resource for other members of the healthcare team and provides education to team members on issues related to the continuum of care, reimbursement, regulatory agency guidelines and resource use. Through collaboration, the Case Manager assures that the treatment plan is implemented accurately, in a cost effective and efficient manner in order to promote customer satisfaction and prevent delays in care and discharge. Responsible for reviewing severity of illness and intensity of service indicators to assure that appropriateness of care criteria is met. Documents reviews and discharge planning in the medical record and/or the computer system as appropriate; Collects and maintains data for tracking and reporting for outcome studies and performance improvement.
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