GENERAL FUNCTION:

This position is responsible for providing utilization review duties and relating effectively with interdepartmental and intradepartmental personnel, medical staff, patients, patients’ families, and outside agencies.

JOB DUTIES:

Thoroughly review assigned cases adhering to procedure for each       specific review type within designated time frame Communicate clearly and effectively in all situations and respond to requests in a timely manner Plan and prioritize daily work to maximize productivity and efficiently manage time Establish and maintain effective working relationships with co-workers, supervisors, administration, and the general public Attend training and develop relevant knowledge skills Adhere to health and safety policy of the hospital Comply with HIPAA/confidentiality guidelines Operate a variety of standard office machines and adhere to procedures relating to the proper use and care of office equipment

MINIMUM QUALIFICATIONS:

RN, LPN, RHIT/RHIA trained or eligible, or non-credentialed person with previous Utilization Review experience and a basic understanding of ICD-10 coding and Interqual criteria.

CONTACTS:

Physicians, nurses, other hospital departments, clinics, and pre-cert companies.

DECISION MAKING:

Distinguishing between pertinent and non-pertinent clinical information. Determining when additional information may need to be requested by physician. Prioritizing daily work to maximize productivity. Deciding when follow up is necessary on incomplete authorizations.

PHYSICAL REQUIREMENTS:

Walking, lifting, pushing/pulling buggies, operating office equipment.

RESPONSIBLE FOR:
Proper use and care of general office equipment including computer, telephone, copier, printer, fax machine, and shred receptacles.