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Utilization Review Coordinator
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- The Utilization Review Coordinator shall maintain an effective, efficient Utilization Review Program and oversees all functions related to admissions and case management.
- Demonstrates the ability to work closely with the Medical Director, Clinical Director, and all clinical staff to ensure that sufficient documentation is present to justify the clinical necessity and appropriateness of admission and continued stay.
- Demonstrates the ability to review cases with insurance/managed care companies/out-of-state entities to include pre-certification, admissions reviews, and continued stay reviews.
- Demonstrates the ability to work with Medical Records regarding documents sent to any insurance/managed care company.
- Participates as an integral member of the treatment team including attendance and knowledge of scheduling of treatment team reviews, special case reviews, and treatment formulation.
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