Utilization Review

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization.

• Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days.
• They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry.
• Facilitates communication between payers, review agencies, healthcare team.
• Identify delays in treatment or inappropriate utilization and serves as a resource.
• Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates resolve payer issues.
• Ensures/Maintains effective communication with Revenue Cycle Department.