Utilization Review Coordinator
WFA Digital Insight
The demand for skilled utilization review coordinators has grown significantly in recent years, with the global healthcare industry seeking professionals who can balance patient care with cost-effective solutions. As the healthcare landscape continues to evolve, roles like this one at Franciscan Health are becoming increasingly important. With the right blend of digital skills and patient care experience, candidates can thrive in this position. The fact that Franciscan Health, a leading Catholic health care system, is hiring for this role remotely highlights the company's flexibility and commitment to attracting top talent. Before applying, candidates should be aware of the need for strong communication skills, the ability to work independently, and a deep understanding of healthcare regulations.
Job Description
About the Role
The Utilization Review Coordinator position at Franciscan Health is a critical component of the healthcare team, responsible for ensuring that patients receive the appropriate level of care while optimizing clinical and financial outcomes. This role involves working closely with physicians, patients, and other healthcare professionals to review and justify admissions and continued stays. The successful candidate will be part of a dynamic team that prioritizes compassionate and comprehensive care.The day-to-day responsibilities of this role are varied and challenging, requiring a strong understanding of patient care, healthcare regulations, and effective communication skills. The Utilization Review Coordinator will conduct concurrent reviews, communicate with various stakeholders, and provide education to patients, families, and staff members. This role is ideal for a motivated professional who is passionate about delivering high-quality patient care and is looking for a challenging and rewarding position.
As a Utilization Review Coordinator at Franciscan Health, the selected candidate will be part of a large Catholic health care system with a strong reputation for providing excellent patient care. The company values its employees and offers a comprehensive benefits package, recognizing the importance of work-life balance and professional development.
What You Will Do
- Perform admission screening for patients to determine medical necessity and appropriateness of setting and utilization.
- Conduct concurrent reviews to optimize clinical and financial outcomes.
- Communicate with physicians, patients, and other healthcare team members to justify admissions and continued stays.
- Provide education to patients, families, and staff members on various aspects of healthcare.
- Act as a resource person for the case management department regarding payer rules, regulations, policies, and procedures.
- Perform admission necessity screening using established criteria from federal, state, and private sector programs.
- Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients.
- Collaborate with the Coordinated Business Office staff, Denial Management staff, and third-party payors to optimize patient care and outcomes.
- Participate in quality improvement initiatives to enhance patient care and satisfaction.
What We Are Looking For
- Associate degree in nursing/patient care required; Bachelor's Degree in nursing/patient care preferred.
- Registered Nurse (RN) licensure in Indiana required.
- At least 3 years of nursing/patient care experience required.
- 2 years of Utilization or Case Management experience preferred.
- Strong understanding of healthcare regulations, including federal, state, and private sector programs.
- Excellent communication and interpersonal skills.
- Ability to work independently and as part of a team.
- Strong analytical and problem-solving skills.
- Knowledge of electronic medical records and other healthcare software.
Nice to Have
- Experience with utilization review and case management software.
- Certification in Case Management (CCM) or a related field.
- Knowledge of managed care principles and practices.
- Experience in a similar role within a large healthcare system.
Benefits and Perks
- Comprehensive benefits package, including medical, dental, and vision insurance.
- Generous paid time off and holiday schedule.
- Opportunities for professional development and continuing education.
- Flexible remote work arrangements.
- Access to cutting-edge technology and software.
- Collaborative and dynamic work environment.
- Recognition and reward programs for outstanding performance.
- Employee assistance programs for work-life balance and wellness.
How to Stand Out
- Ensure your resume highlights your experience in nursing or patient care, as well as any relevant certifications or education.
- Be prepared to discuss specific examples of how you have optimized patient care and outcomes in your previous roles.
- Familiarize yourself with the company's values and mission to demonstrate your fit with the organization's culture.
- Develop a strong understanding of healthcare regulations and managed care principles to excel in this position.
- Consider obtaining certifications like the Certified Case Manager (CCM) to enhance your career prospects and demonstrate your expertise.
- Prepare to discuss your experience with electronic medical records and other healthcare software, and be ready to learn new systems.
- Research the company's benefits and perks to understand the total compensation package and how it aligns with your needs and goals.
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