Job Description
Job Summary and Responsibilities
Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking. Reviews include admission, concurrent and post discharge for appropriate status determination.
Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders
regarding review outcomes.
Collaborates with facility RN Care Coordinators to ensure progression of care.
Engages the second level physician reviewer, internal or exter...