Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Description:
Could you be our next Clinical Reimbursement Manager-Utilization Review at HomeCare & Hospice?
Why work as a Clinical Reimbursement Manager with Main Line Health?
Position: Clinical Reimbursement Manager-UR
Shift: Every other weekend day shift
Experience:
1. Three to five year’s clinical experience with at least two years home care experience required.
2. Basic computer skills required, knowledge of home health information system a plus
3. Knowledge of Medicare regulations pertaining to Home Health, expertise in Home
4. Health Coding preferred.
Education:
1. Graduate of an accredited School of Nursing required.
2. Associate’s degree required.
3. Bachelor’s degree preferred.
Licensures/Certifications:
1. Current licensure in the Commonwealth of Pennsylvania as a Registered Nurse required.
2. Valid driver’s license and insured automobile required.
3. Home Care Coding Specialist Certification as described above required.