Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned.Responsibilities
Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting.
#LI-ER3QualificationsMedical Graduate, PA, or Nursing Graduate required. Must meet the performance standards set forth by the Hospital/ Department at UR Coordinator I position for at least 6 months.In order to be promoted to UR Coordinator II position; the Employee must meet certain performance standards as defined by the Hospital/Department.In order to be promoted to Corporate Case Manager position; the Employee must meet certain performance standards as defined by the Hospital/ Department and obtain the Certified Case Manager credential. 1+ year of utilization review experience is highly preferred.
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