Utilization Management Coordinator

Description

Reviews hospital inpatient charts in accordance with the utilization management plan to assure compliance with accrediting agencies and federal regulations. Determines basis for appropriate level of care utilizing knowledge of disease processes, treatment and outcomes along with medical necessity criteria. Communicates concurrent review analyses to third party payers, physician, multidisciplinary team and financial services. Completes all aspects of the authorization process, negotiating appropriate reimbursement for patient care services. Collects and analyzes data on the use of hospital resources. Refers cases to Physician Advisor, Discharge Planning or Social Work when inpatients do not meet established criteria, discharge planning is needed or hospital resources are not being used efficiently. Under FLSA, incumbents in this position are nonexempt.