Utilization Review Coordinator

Job ID: 34528

About the role

The Utilization Review Coordinator's primary responsibility is to monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. The coordinator will ensure that all patients admitted to EH are appropriate for admission to the hospital and are at the correct level of care. They will ensure that clinical reviews are given to the payer care manager in a timely manner and that potential denials in care are addressed concurrently to prevent retrospective denials. This will involve communication and collaboration with payer care managers to understand their clinical criteria, appeal process, and collaboration while the patient is in house to prevent or minimize retrospective denials.

Requirements

• RN licensure required, BSN preferred
• 3 years of hospital case management or utilization management experience

Pay

$45.00 - $65.00 / Hourly

Schedule

• Full Time
• Day shift: 8:00 AM - 4:30 PM