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Utilization Review Coordinator

2 months ago

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

We are seeking a highly skilled Utilization Review Coordinator to join our team at Christus Health. As a key member of our Case Management department, you will play a critical role in ensuring the medical necessity of patient hospitalizations and the appropriate level of care.

Key Responsibilities
  • Utilize approved screening criteria to determine medical necessity and appropriate level of care for patients.
  • Actively manage patient status and LOC, providing consultative support 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.
  • Excellent reading, writing, and editing skills in English.
  • Strong organizational skills and ability to effectively evaluate physician orders and medical records.
  • Competent computer skills for word processing, data collection, and retrieval.
Preferred Qualifications
  • 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.
Work Environment

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

Physical Requirements

The Utilization Review Coordinator must be able to move around the hospital to all units/departments for about 10% of the day, with the majority of the time spent in an office setting. Close work, good vision, and dexterity to write and use a computer keyboard are required.