Utilization Management Coordinator

Utilization Management Coordinators are responsible for carrying out the day-to-day operations of the healthcare management program as they relate to the utilization management process. We are seeking a team-oriented, positive and professional individual who possesses exceptional communication and organizational skills.

Responsibilities

• Perform prospective, concurrent and retrospective clinical reviews to determine and ensure the medical necessity of requested treatment, hospital admissions, continued stays and/or services in accordance with defined criteria.
• Assist with discharge planning coordination; refer appropriate cases to case management assessments as needed.
• Verify participant eligibility and benefits to certifications as required.
• Refer cases to consulting physician reviewer as necessary.

Required Experience

• Active Michigan Nursing license required
• At least 3 years of recent acute care hospital experience or utilization management experience preferred
• Some experience in ICU, CCU and/or Oncology is preferred
• Strong customer service orientation with solid typing, organizational and multi-tasking skills

Applicants will be required to undergo a pre-employment screening process which includes a drug screen and background check