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.