Utilization Coordinator
On-siteRio Piedras, Departamento del Magdalena, Republic of Colombia or Rio Piedras, Salta Province, Argentine Republic
Job Summary
Monitor patient length of stay and extensions while acting as a liaison between managed care organizations and clinical staff. Conduct quality reviews for medical necessity, coordinate communication regarding reimbursement requirements, and gather statistical information on utilization and non-certified days. Initiate formal appeals for denied admissions, assist with pre-certifications, and facilitate peer review calls between the facility and external organizations. Provide ongoing staff training on documentation, charting requirements, and continued stay criteria.
Required Qualifications
- High school diploma or equivalent
- Clinical experience
- Two or more years' experience working with the facility's population
- CPR and de-escalation and restraint certification
- First aid
Desired Qualifications
- Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field
- Previous experience in utilization management
- LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services
- Current clinical professional license or certification, as required, within the state where the facility provides services
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