Utilization Review Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct concurrent reviews to ensure the appropriateness of utilization, aiming to enhance both clinical and financial outcomes.

• Engage in communication with physicians, patients, members of the Healthcare team, Coordinated Business Office personnel, Denial Management staff, and third-party payers to validate admissions or continued stays.

• Inform relevant staff members regarding admissions, services, duration of stay, absence of medical necessity criteria, and manage denials/appeals, including issuing letters to patients.

• Provide education to Physicians, Patients, Families, Staff, and Students.

• Serve as a resource for the case management department concerning payer rules, regulations, policies, procedures, and utilization concerns.

• Execute admission necessity screenings based on criteria set forth by various federal, state, and private sector programs.

⛳️ Requirements

• An Associate degree in nursing/patient care is required.

• A Bachelor's Degree in nursing/patient care is preferred.

• Current Registered Nurse (RN - Indiana licensure) is required.

• A minimum of 3 years of nursing/patient care experience is required.

• At least 2 years of experience in Utilization or Case Management is preferred.

🏝️ Benefits

• A comprehensive range of benefit offerings.