Case Management Coordinator - Utilization Review Specialist

Education: Must have a Bachelors degree; Masters degree or RN license preferred.

Assure residents meet criteria for admission, and review initial clinical information through discharge.

Monitor and manage client/patient/resident’s cases through development and implementation of individual care plans, collecting clinical data and remain informed by continuous review of documentation.

Coordinate care by tracking, monitoring, and reporting on inpatient or outpatient care.

Manage client/patient/resident’s cases with knowledge and expertise with the patient population of the facility.

Convey medical criteria and clinical information between the client/patient/residents’ insurance provider and treatment team as warranted and may also provide this information to the business office, as needed.

Conduct precertification with third party payers and negotiate approved days with the provider for the patient/resident admission.

Assigned tasks for admission review, concurrent review and participate in discharge planning.