Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve.
Utilization Review Coordinator
Location
United States
Posted
3 days ago
Salary
$57.0K - $84.8K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Review Coordinator
Franciscan Alliance, Inc.
Role Description The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization. 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. Qualifications - 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 Requirements - TRAVEL IS REQUIRED: Never or Rarely - JOB RANGE: Utilization Review Coordinator $56971.20-$84749.60 - INCENTIVE: Not Applicable Benefits Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
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