Full Time Utilization Review Coordinator

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Team Bronson is compassionate, resilient and strong. We are driven by Positivity which inspires us to be our best and to go above and beyond for our patients, for one another, and for our community. 

If you’re ready for a rewarding new career, join Team Bronson and be part of the experience.

Location

BHG Bronson Healthcare Group

Title

Full Time Utilization Review Coordinator

Responsible for fulfilling the Hospital Utilization Management policies and procedures by performing review of scheduled and/or unscheduled patient admissions from admit date through discharge for appropriate level of care classification. Analyzes patient medical record and makes level of care classification decisions. Applies knowledge of nationally recognized admission criteria (i.e. InterQual) when appropriate. Communicates review decisions with patient's health plan and obtains health plan authorization for reimbursement of admission. Works in partnership with the healthcare team to resolve classification or authorization issues. Employees providing direct patient care must demonstrate competencies specific to the population served. BSN required. Work schedule requires every other weekend rotation.

Current RN license in the state of Michigan required. 

Effective 11/1/2021, BSN required for all new hires.  

Work schedule requires every other weekend rotation.

• Expert knowledge of InterQual Level of Care Criteria or MCG.

• Demonstrated ability to work independently, think critically, and perform a variety of duties often changing from one task to another of a different nature without loss of efficiency.

• Demonstrated computer skills required.

• Demonstrated effective communication skills.

• Must have excellent customer service skills.

• Communication with all payers to ensure appropriate level of care classification; obtains precertification forms from third party payers as required.

• Conducts inpatient pre-admission and admission review for Medicare and Medicaid beneficiaries as well as private insurance members and self-pay patients based on CMS guidelines.

 • Proactively confers with the admitting physician to providing coaching on accurate level of care determination at point of hospital entry.

• Collaborates with the community physicians and hospitalists to influence accurate status determination.  

• Educates members of the patient’s care team on the appropriate access to and use of various levels of care.

• Represents Utilization Management at various committees, professional organizations, and physician groups as needed.

• Maintains complete, accurate documentation of all utilization review activities.

• Meets with physicians to evaluate patient’s status and admission criteria when appropriate. Provides physician education regarding orders, status, and payor regulations as necessary.

• Status changes to include updates to Event Manager in Epic

• Follow CMS rules and regulations in regards to 2-midnight rule and appropriately signed orders.

• Self-audit workgroup responsibilities – working with Physician Advisor on potential at risk cases.

• Utilize payor web sites for efficiency in obtaining authorization.

• Follows and provides input for the Insurance Grid in which update is ongoing.

• Monitors Observation Report to insure patient status is current.

• Writes Telephone Order Read Back (TORB) as needed for appropriate patient status.

• Rotates weekend coverage.

Work may produce levels of mental/visual fatigue which are typical of jobs that perform a wide variety of duties with frequent and significant uncontrollable deadlines. Work may include the operation of and full attention to a personal computer. The job produces some physical demands. Typical of jobs that require sitting at a computer to perform job duties

Shift

First Shift

Time Type

Full time

Scheduled Weekly Hours

40

Cost Center

2455 Utilization Management (BHG)

Agency Use Policy and Agency Submittal Disclaimer

Bronson Healthcare Group and its affiliates (“Bronson”) strictly prohibit the acceptance of unsolicited resumes from individual recruiters or third-party recruiting agencies ("Recruiters") in response to job postings or word of mouth. Unsolicited resumes sent to any employee of Bronson by Recruiters, without both a valid written agreement with Bronson and a direct written request from the Bronson Talent