RN UR - South Central Regional Medical Center

UTILIZATION REVIEW
POSITION DESCRIPTION
SOUTH CENTRAL REGIONAL MEDICAL CENTER

POSITION TITLE:Utilization Reviewer DATE: 08/02/2017
REPORTS TO: Director, Utilization Review

DEPARTMENT: Utilization Review PREPARED BY: Krystal Smiley

GENERAL FUNCTION:

This position is responsible for providing utilization review duties and relating effectively with interdepartmental and intradepartmental personnel, medical staff, patients, patients’ families, and outside agencies.

JOB DUTIES:

• Operate a variety of standard office machines and adhere to procedures relating to the proper use and care of office equipment

MINIMUM QUALIFICATIONS:

RN, LPN, RHIT/RHIA trained or eligible, or non-credentialed person with previous Utilization Review experience and a basic understanding of ICD-10 coding and Interqual criteria.

CONTACTS:

Physicians, nurses, other hospital departments, clinics, and pre-cert companies.

DECISION MAKING:

• Distinguishing between pertinent and non-pertinent clinical information.
• Determining when additional information may need to be requested by physician.
• Prioritizing daily work to maximize productivity.

• Deciding when follow up is necessary on incomplete authorizations.

PHYSICAL REQUIREMENTS:

Walking, lifting, pushing/pulling buggies, operating office equipment.

RESPONSIBLE FOR:
Proper use and care of general office equipment including computer, telephone, copier, printer, fax machine, and shred receptacles.

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