Utilization Review Coordinator
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Job Description
Utilization Review Coordinator responsible for patient admission screening and concurrent reviews at Franciscan Health. Collaborating with healthcare teams to ensure medical necessity and utilization benefits.
Responsibilities:
- Perform admission screening for patients in a bed for medical necessity
- Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes
- Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay
- Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients
- Provide Physician, Patient, Family, Staff and Student education
- Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues
- Perform admission necessity screening using criteria as established by the various federal, state and private sector programs
Requirements:
- Associate degree in nursing/patient care required
- Bachelor's Degree in nursing/patient care preferred
- Registered Nurse (RN - Indiana licensure) required
- 3 years of nursing/patient care experience required
- 2 years of Utilization or Case Management experience preferred
Benefits:
- Comprehensive benefit offerings
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