Three years acute care utilization management experience
Proficiency with interqual and mcg criteria
Experience with epic ehr and payer portals
The Utilization Review Coordinator is responsible for conducting the review process in accordance with federal law, hospital standards, and third-party payor requirements
Job Summary
The Utilization Review Coordinator is responsible for conducting the review process in accordance with federal law, hospital standards, and third-party payor requirements.
The role requires analyzing clinical information to determine appropriate levels of care and obtaining necessary authorizations for reimbursement.
Candidates must demonstrate competency with InterQual and MCG criteria while managing denial appeals and coordinating peer-to-peer discussions.
Matching Summary
The Utilization Review Coordinator is responsible for conducting the review process in accordance with federal law, hospital standards, and third-party payor requirements.
Skills & Requirements
Must-have
Three years acute care utilization management experience
Proficiency with InterQual and MCG criteria
Experience with EPIC EHR and payer portals
Knowledge of health plan contracts and reimbursement
Ability to manage DNFB lists and denial appeals
Nice-to-have
Master's degree in social work or counseling
Bachelor's-level RN license
RHIT certification preferred
LPN license preferred
Experience with behavioral health services
Key Requirements
Associate's degree in health-related field or nursing
Three years of recent acute care utilization management experience
Current RHIT or LPN license preferred
Master's degree in social work or counseling (for ECT functions)