Utilization Review Coordinator

Job not on LinkedIn

🕒 3 days ago

🇺🇸 United States – Remote

💵 $57k - $84.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Franciscan Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1875

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Franciscan Health is a healthcare organization committed to providing high-quality medical care grounded in the Franciscan tradition. They offer a range of medical services, including clinical and allied health, home health and hospice, nursing, physicians and advanced practice providers, and non-clinical and administrative roles. With a focus on embracing the values of St. Francis to care for those in need, they provide a supportive and fulfilling work environment for their employees, emphasizing a mission of compassion and community engagement. Franciscan Health is dedicated to offering a variety of employment opportunities across different medical specialties and locations.

📋 Description

• 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