RN Utilization Review Coordinator

As a Valleywise Utilization Review RN Coordinator, you are part of a multidisciplinary team providing exceptional care to our patients. As a Utilization Review RN Coordinator, you work under the direction of the Manager of Care Management as part of the inpatient Care Management Team. You are responsible for determining the appropriateness of patient status and medical necessity for services provided through the acute care medical hospital. This requires proficiency in clinical criteria, evidence-based practice, regulatory compliance, reimbursement sources, and the health care delivery system. The RN Utilization Review Coordinator is responsible for assuring the appropriate use of resources and facilitating the patients progression through the continuum of care in a timely and cost-effective manner. This position works with managed care plans, third-party payers, the business office, and the interdisciplinary team to ensure authorization for reimbursement at the appropriate level is confirmed to ensure payment of expected reimbursement.