Utilization Review Coordinator

With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization. Schedule: Friday - Sunday, 5pm - 5am

Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes. Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay. 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. Provide Physician, Patient, Family, Staff and Student education. Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues. Perform admission necessity screening using criteria as established by the various federal, state and private sector programs.