The Utilization Review Coordinator performs admission screenings to determine medical necessity and appropriateness of care settings. They also communicate with healthcare teams and payors to optimize clinical and financial outcomes while managing denials and appeals.
Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization.
With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Schedule: Monday - Friday, 8am - 4:30pm EST 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.
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 TRAVEL IS REQUIRED: Never or Rarely JOB RANGE: Utilization Review Coordinator $56971.20-$84749.60 INCENTIVE: Not Applicable EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
Candidates must hold an Associate degree in nursing or patient care and possess a valid Indiana Registered Nurse (RN) license. A minimum of 3 years of nursing or patient care experience is required for this role.
Medical Assistant or LPN
Registered Nurse .5 FTE
Medical Assistant II Float Physician Practice