The Utilization Review Coordinator in Integrated Care is responsible for assisting the Assistant Director in overseeing day-to-day operations within the department with a specific focus on utilization review management. Responsible for establishing appropriate staffing levels and work assignments, developing performance criteria for staff, serving as an expert resource on laws, policies and operational procedures, and ensuring that the operations of the department are consistent with organizational standards.

DUTIES AND RESPONSIBILITIES:

Assists in overseeing secondary review process, utilization review management, audit and denial process for all level of care decisions Audits leveling assignments; provides reports to measure outcomes and reports regularly to the manager and director of the department Oversees activities of staff by attending unit rounds, review of medical record documentation, and evaluation of use of system tools for decision support. Provides ongoing departmental education in arenas of utilization management, discharge planning and inter-rater reliability. Identifies appropriate staffing levels, assignments and deployments for the department. Monitors performance criteria for staff members. Reviews operations of the department to ensure high level of quality is consistent with organization standards.