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Utilization Review Coordinator Case Management PT/24 HRS
DescriptionRegistered Nurse uses approved screening criteria (Milliman®/Interqual®/CMS Inpatient List) to determine the medical necessity of a requested hospitalization and the appropriate level of care for that patient. Actively involved in management of inpatient observation patients. Provides consultative role as utilization management nurse to clinical and non-clinical departments. Documents objective findings against approved indicators. Assists with retrospective reviews and medical necessity denials per communication with third party payors. Follows UM policies and procedures and assists with continually improving the quality and effectiveness of the utilization management program at CSVRMC.


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