Utilization Review Coordinator
5 days ago
Description
1. Communicates with Admitting or PFS regarding the needs of the patient, payer and provider.2. Communicates relevant elements of the patient's health plan benefits.3. Completes medical necessity utilization reviews and documents those reviews in MIDAS+ within required timeframes.4. Reviews every inpatient admission and observation order for appropriateness based on InterQual Evidenced Based criteria within the required timeframes and follows the approved utilization review procedures if the patient status order is not consistent with the medical necessity assessment.5. Notifies Admitting Department of errors or needed changes in patient data including changes in physician orders/incorrect admission status designation. 6. Reviews record including physician orders and documents admission, concurrent, discharge reviews and retrospective reviews as assigned. 7. Communicates with physicians regarding the level of care or admission status when appropriate criteria are not met for inpatient, observation or continued stay. 8. Refers cases to the Case Management leadership and/or Case Management Medical Director as needed and documents the referral. 9. Provides and documents concurrent reviews or other information requested by the payer within required timeframes.10. Demonstrates responsibility for professional development and growth including identifying continuing education needs and seeking learning opportunities that will enhance job performance and professional satisfaction. 11. Demonstrates compliance with facility and departmental safety and security policies and practices. 12. Educates hospital team members and physicians about the Utilization Management RN and scope of practice. 13. Supports the hospital quality, risk and performance improvement programs. 14. Other job functions as assigned. Education Benefit Statement For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes: Medical, dental and vision insuranceEmployer paid group term life and disabilityEmployer contribution toward Health Savings AccountFlexible Spending AccountsPaid Time Off (PTO), Paid Holidays and Paid Parental Leave403(b) with a 5% employer matchVarious voluntary benefits:Supplemental Life, AD&D and Disability
Critical Illness, Accident and Hospital Indemnity coverage
Tuition assistance
Student loan servicing and support
Adoption benefits
Backup Childcare and Eldercare
Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
Discount on services at Lurie Children's facilities
Discount purchasing program
There's a Place for You with Us At Lurie Children's we embrace and celebrate diversity and equity in a serious way. We are committed to building a team with a variety of backgrounds, skills, and viewpoints — recognizing that diverse identities strengthen our workplace and the care we can provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging and allyship. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care. Support email:-
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