Utilization Manager
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JOB SUMMARY
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The utilization manager is responsible for the development of a comprehensive and goal oriented plan of care as it relates to effective utilization of available health services, review of the medical necessity of patient admissions, and review of the medical necessity for continued stay in the hospital; the analysis of patient records to ensure compliance with government and insurance company reimbursement policies, and determining patient review dates according to established diagnostic criteria; Acting as a liaison between the patient, the clinical team, and the payer; the management of individual caseloads of patients that are non-Medicare through completion of concurrent reviews, communication with interdisciplinary team and appealing denied days.
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ESSENTIAL FUNCTIONS
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QUALIFICATIONS:
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To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
PI93de1a493140-37437-40337793
