Utilization Management Coordinator

Corewell Health · Southfield, MI · 1 wk ago

Information TechnologyPart-time

About the Role

This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.

Qualifications

Associate's Degree (required); Bachelor's Degree in nursing or related field (preferred)
2 years of relevant experience
2 years of experience in a clinical/hospital setting
Hospital utilization review/utilization management experience (required)
Clinical appeals experience (preferred)
LIC-Registered Nurse (RN) - State of Michigan (required upon hire)

Physical Demands

Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 50 lbs
Waist to Waist > 5 lbs: Seldom up to 50 lbs
Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
Waist to Overhead > 5 lbs: Seldom up to 5 lbs
Bilateral Carry > 5 lbs: Seldom up to 25 lbs
Unilateral Carry > 5 lbs: Seldom up to 10 lbs
Pushing Force > 5 lbs: Occasionally up to 25 lbs
Pulling Force > 5 lbs: Occasionally up to 20 lbs
Sitting: Occasionally
Standing: Frequently
Walking: Frequently
Forward Bend - Standing: Occasionally
Forward Bend - Sitting: Occasionally
Trunk Rotation - Standing: Occasionally
Trunk Rotation - Sitting: Occasionally
Squat: Seldom
Stair Climbing: Seldom
Crawling / Kneeling: Seldom
Reach - Above Shoulder: Occasionally
Reach - at Shoulder or Below: Occasionally
Handling: Occasionally
Forceful Grip > 5 lbs: Occasionally
Forceful Pinch > 2 lbs: Occasionally
Finger/Hand Dexterity: Frequently
Visual Acuity: Seldom required
Color Vision (Ishihara) Test: Seldom required

Benefits

Comprehensive benefits package to meet financial, health, and work/life balance goals
On-demand pay program powered by Payactiv
Discounts directory with deals on restaurants, phone plans, spas, and more
Optional identity theft protection, home and auto insurance
Traditional and Roth retirement options with service contribution and match savings

Schedule

Employment Type: Part time
Shift: Day (8AM-4:30PM)
Weekly Scheduled Hours: 20
Days Worked: 2-3 days per work week