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)
Job Summary:
At Gritman, we pride ourselves on being the premier healthcare employer on the Palouse. We bring exceptional care that’s close to home for the members of our community, We are seeking a Staff RN to join our Utilization Review/Case Management team. The Utilization Review Nurse (UR) has skills in areas of Utilization Management (UM), medical necessity and patient status determination. This includes examining medical records, treatment and interventions to assist in avoiding payment denials and optimizing reimbursements by assessing the treatment’s appropriateness effectiveness, timing and setting based on the regulatory and reimbursement requirements of various commercial and government payers. At times the UR nurse may assist in overseeing the patient discharge plan and play a role in designing after care plans.
Responsibilities:
Essential Skills:
Requirements:
Education:
Associates or better in nursing
Experience:
Preferred:
2-3 years acute care experience
Utilization Review experience
Will train the right individual seeking to learn a new unique skill set