Utilization Review Coordinator
On-siteIndianapolis, Indiana, United States
Job Summary
Coordinate patients' services across the continuum of care by promoting effective utilization, monitoring health resources, and collaborating with multidisciplinary teams. File documents as needed and perform initial precertification and concurrent clinical reviews with payors. Document daily in the electronic system in real time, conduct admission audits, and ensure CONs/RONs and CMS certifications are completed by providers. Assist with appeals, arrange peer-to-peer reviews, and report outcomes to leadership. Provide education to nursing staff, leadership, and providers regarding documentation while maintaining knowledge of current field trends. Actively work with the business office to resolve appeals and denials.
Required Qualifications
- Bachelor's in Behavioral Health, Social Work, Counseling, Nursing or Psychology
- Minimum of 2 years of utilization review experience in a hospital setting
- Minimum of 2 years of case management experience, including discharge planning in a hospital setting
- Must have strong knowledge of medications
- Exceptional time management skills
- Exceptional communication skills
- Detail oriented
Desired Qualifications
- Master's degree
- Certified Case Manager (CCM)
- Accredited Case Manager (ACM)
- Basic Life Support (BLS)
- Handle with Care (HWC)
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