Utilization Review Case Coordinator
Department: Quality Management
Type: FTE: 0.8 Part-Time
About the Job:
The Coordinator of Utilization Review/Case Management is responsible for the direction of the Utilization Review Programs at Ashland Memorial Medical Center and Hayward Area Memorial Hospital.
Utilization Review:Responsible for the coordination and direction of all utilization review activities to support and implement the goals of the utilization review program and plan. Maintains oversight responsibility for the review of usage patterns for medical necessity and appropriateness of care against screening criteria documenting same in computerized database. Responsible for authorization of appropriate services; inputs authorizations and utilizes utilization review component of hospital computer system. Assists the medical direction with all utilization activities as requested and directed. Prepares meeting materials for the Utilization Review Committee. Responsible for coordination and presentation of utilization review program, routine utilization review audits. Adheres to the regulatory and accreditation requirements. Responsible for the operational aspect of the authorization process. Enters authorization and tracking numbers into the computer system for pre-certification cases. Reviews all information from the patient’s insurance company and physicians. Participates in Quality Improvement activities.
Swing Bed and Discharge Oversight: Assesses and evaluates the needs of patients for discharge planning, including SWING BED placement at HAMH and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance. Discharge planning is coordinated with physicians, Nursing, Social Services, patients and those significant others who have an ongoing caring relationship with the patient. Adheres to the regulatory and accreditation requirements regarding discharge planning.
Primary Work Location: Hayward, WI
- RN or LPN with at least 2 years nursing experience, preferably in acute care.
- Within 3 months of hire, masters necessary computer skills re: InterQual, Excel, Word and Clinical Documentation in Epic.
- Current WI nursing license (RN or LPN)
Shift Time: 8-hour Shifts
Benefits and Salary:
Commensurate with position and experience. Comprehensive benefits package to include: medical, HSA, dental, 403(b) with employer match of 5%, PTO, wellness benefits, etc.
MMC is a regional medical center that serves patients from 7 counties in northwest Wisconsin and Gogebic County in Michigan. We have more than 60 full-time physicians and specialists on-staff and over 600 employees who are dedicated to providing quality care. Our charming city of Ashland, WI is located on the shores of Lake Superior near Bayfield and the 21 Apostle Islands, and boasts a strong community, historic charm, modern conveniences and abundant opportunities for outdoor recreation. Our passion and driving force is to see the people of our community live healthy, productive lives.Apply Now