RN - Utilization Reviewer - Coordinated Care - PT
University of Mississippi Medical Center(1 month ago)
About this role
The RN - Utilization Reviewer performs utilization management for a designated patient caseload, conducting prospective, concurrent, retrospective, and denial reviews using clinical protocols and medical necessity criteria. The role monitors quality of care issues, communicates findings to appropriate managers, and supports care coordination and discharge planning processes to ensure appropriate, cost-effective patient management.
Required Skills
- Utilization Review
- Case Management
- Medical Necessity
- Discharge Planning
- Care Coordination
- Clinical Documentation
- ICD-10
- CPT
- Data Analysis
- Communication
+2 more
Qualifications
- Valid RN License
- CPUM (Preferred)
- ACM (Preferred)
- CCM (Preferred)
About University of Mississippi Medical Center
umc.eduUMMC educates health care professionals, conducts health sciences research, provides leading patient care and eliminates health care disparities.
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