What are the responsibilities and job description for the Utilization Review/Denials Management Coordinator- Full Time- Southern Maryland Hospital position at medstar-pilot?
The primary responsibility of the Utilization Review (UR) and Denials Management Nurse is to utilize clinical expertise to interface with contracted third party vendor, VPMA or designated Physician Advisor, Providers, case management staff and other associates to facilitate timely review of the appropriateness and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis and to support optimal hospital throughput and appropriate reimbursement for services rendered.
