Utilization Review Coordinator

1 week ago


Santa Fe, New Mexico, United States CHRISTUS Health Full time
Job Summary

Christus Health is seeking a highly skilled Utilization Review Coordinator to join our team. As a key member of our clinical staff, you will play a critical role in ensuring the medical necessity of hospitalizations and the appropriate level of care for patients.

Key Responsibilities
  • Utilize approved screening criteria to determine medical necessity and level of care for patients.
  • Actively manage patient status and provide consultative services to clinical and non-clinical departments.
  • Document objective findings against approved indicators and assist with retrospective reviews and medical necessity denials.
  • Collaborate with third-party payors to ensure compliance with UR policies and procedures.
Requirements
  • Graduate of an approved school of nursing, BSN preferred.
  • Current licensure as an RN in New Mexico mandatory.
  • Minimum of five years of experience in a healthcare setting, with a minimum of two years in an acute care setting.
  • Experience with utilization management, knowledge of MCG/criteria, managed care language, and CMS rules and regulations preferred.
Work Environment

This is an office-based position with rotating shifts and weekends as needed. The ideal candidate will be able to adjust to frequently changing workloads and frequent interruptions.

Physical Requirements

The Utilization Review Coordinator will be required to move around the hospital to all units/departments for approximately 10% of the day, with the majority of the time spent in an office setting.



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