Job Summary:

The Utilization Review Coordinator will monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services and monitor the appropriateness of hospital admissions and extended hospitals stays.

Supervisory Responsibilities:

• None.

Duties/Responsibilities:

• Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
• Coordinates and supervises the activities of the Utilization Review Department.
• Calculates the lengths of stay and continued-stay days for patients.
• Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or continued stay.
• Assists the Utilization Review Committee in the assessment and resolution of utilization review problems.
• Identifies problems related to the quality of patient care and refers them to the Quality Assurance Committee.
• Maintains communication with the Social Service Department to facilitate timely discharge planning.
• Compiles monthly reports and statistics for presentation to the Utilization Review Committee.

Required Skills/Abilities:

• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Excellent time management skills with a proven ability to meet deadlines.
• Proficient with Microsoft Office Suite or related software.

Education and Experience:

• B.A. or equivalent in nursing required
• Licensed and currently state-registered nurse.
• One to two years of utilization review experience.

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.