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Description:

POSITION PURPOSE
The Utilization Review (UR) Coordinator I colleague is responsible for conducting the utilization review process in accordance with federal and state law, licensure/ accreditation and hospital standards and Third-Party payor requirements. The review process includes but is not limited to admission/re-admission review (includes identification of fragmentation of care, combined admissions), pre-certification/re-certification review, data gathering for identified projects, internal audits, retrospective reviews, statistics, coding, billing or verification issues.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES MAY INCLUDE
1. Provides leadership and expertise for utilization management processes.
2. Completes the UR review and obtains authorization on retrospective cases that the insurance has changed after discharge by performing the...