The Coordinator for Utilization Management assists with the coordination and supervision of daily operations of the utilization team and utilization process in Utilization Management. The Coordinator is responsible for the education and coordination of activities that promote accurate and efficient application of screening criteria used for utilization and ensures appropriateness of the services being provided. Takes direction from the department manager and director. Collaborates with department members and other departments involved in the patient's plan of care. Ensures a culture of accountability and demonstrates the ability to problem solve.
Graduation from an accredited School Of Nursing. BSN graduate preferred.
Required length and type of experience:
Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Case Management or Utilization Review) needed
Previous Utilization, Care Management, Case Management or Care Coordination experience required in the last three years preferred in a hospital setting
Have current knowledge/application of Interqual and/or Milliman criteria
Understanding of Medicare regulations pertaining to utilization management needed
Excellent critical thinking and communication skills are necessary
Strong computer skills needed
Prior supervisory/leadership experience helpful
Previous commercial insurance experience helpful
Required licensure, certification or registry:
Registered Nurse with the State of Ohio.
Internal Number: 13955
About Southwest General Health Center
Southwest General is home to nationally recognized physicians, state-of-the-art technology and a full range of medical, surgical and emergency services, including a Level III trauma center. Our services are designed to provide patients with care that addresses their physical, mental, emotional and spiritual needs.
At Southwest General we are committed to embracing diversity and inclusion as one of our core values. It is our tradition to respect, appreciate, embrace and seek others who are of different backgrounds, experiences, ethnicities and affiliations. We believe such differences enable us to provide more compassionate care to our patients, each other and our communities. Our differences make us more cohesive, more empowered and more advanced.
If you want to make a difference in people’s lives and help support our community through compassionate, quality medical care, we want to hear from you! At Southwest General, one of the factors that continue to set us apart is our team of medical professionals and support staff who truly care about our community and believe in the work we do. In turn, we focus on providing opportunities for professional growth and development, increased wellness, personal fulfillment and a healthy work/life balance.