Utilization Review Coordinator
Posted 2025-03-14Utilization Review Coordinator
locationsWork From Home
time typePart time
posted onPosted 30+ Days Ago
job requisition idR-108517
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 that provide compassionate, comprehensive care for our patients and the communities we serve.
WHAT YOU CAN EXPECT
? Complete medical necessity review of charts.
? Communicate with insurance companies when indicated to provide clinical reviews to obtain authorization for hospital stays.
? Refer cases not meeting InterQual/Milliman criteria to Physician Advisor for evaluation and follow through with recommendations.
? Consult with the physician whenever admission or continued stay does not meet approved criteria and cannot justify the admission or continuation of hospitalization.
? Monitor and complete cases as identified on initial, concurrent and discharged review work queue.
? Monitor and complete cases on the Stop Bill, Auth Cert Pending Discharged work queues, as well as others as identified by supervisor.
? Actively communicate with and assist Case Managers
? Support compliance with HFAP, State, and Federal Agencies for assigned areas.
? Keep abreast of current trends in Utilization Review and Managed Care processes.
? Maintain current knowledge of Medicare, Medicaid, and third party payor rules.
? Maintain accurate, concise, and timely documentation in Epic.
QUALIFICATIONS
? Associate degree in nursing/patient care required
? Bachelor's Degree in nursing/patient care preferred
? Registered Nurse (RN - Indiana AND Illinois licensure) required
? 3 years of nursing/patient care experience required
? 2 years of Utilization or Case Management experience preferred
? *Please note that the schedule for this position is as follows: Friday and Saturday, 5pm-5am CST, Thursday: 6pm ? 10pm CST
Never or Rarely requires travel.
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