Utilization Management Coordinator

Scope of Work This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.

Qualifications

Required Associate's Degree Associates or technical degree. Preferred Bachelor's Degree in nursing or related field. 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required Hospital utilization review/utilization management experience. Preferred Clinical appeals experience. Preferred LIC-Registered Nurse (RN) - STATE_MI State of Michigan Upon Hire required Physical Demands Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 50 lbs Waist to Waist > 5 lbs: Seldom up to 50 lbs Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs Waist to Overhead > 5 lbs: Seldom up to 5 lbs Bilateral Carry > 5 lbs: Seldom up to 25 lbs Unilateral Carry > 5 lbs: Seldom up to 10 lbs Pushing Force > 5 lbs: Occasionally up to 25 lbs Pulling Force > 5 lbs: Occasionally up to 20 lbs Sitting: Occasionally Standing: Frequently Walking: Frequently Forward Bend - Standing: Occasionally Forward Bend - Sitting: Occasionally Trunk Rotation - Standing: Occasionally Trunk Rotation - Sitting: Occasionally Squat: Seldom Stair Climbing: Seldom Crawling / Kneeling: Seldom Reach - Above Shoulder: Occasionally Reach - at Shoulder or Below: Occasionally Handling: Occasionally Forceful Grip > 5 lbs: Occasionally Forceful Pinch > 2 lbs: Occasionally Finger/Hand Dexterity: Frequently Visual Acuity ¹ [None = No; Seldom = Yes]: Seldom Color Vision (Ishihara) Test [None = No; Seldom = Yes]: Seldom

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• Optional identity theft protection, home and auto insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd Department Name Utilization Management - Diversified East WB Mkt Employment Type Part time Shift Day (United States of America) Weekly Scheduled Hours 20 Hours of Work 8AM-4:30PM Days Worked 2-3 days per work week Weekend Frequency N/A CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account.
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