Utilization review nurse vs utilization review coordinator

Differences between utilization review nurse and utilization review coordinator duties and responsibilities

Utilization review nurse example responsibilities.

• Monitor patients' status during surgery (circulate in operating room) and manage patients in PACU.
• Case management for acute patients refer to LTC
• Advise insurance carriers on recommend reimbursement for charges following automate bill audit utilizing ICD-9 and CPT codes.
• Provide caregiver oversight relate to care, medication administration and emergency situations.
• Identify inappropriate utilization of services/settings through the application of establish clinical criteria using InterQual and CMS guidelines for medical necessity.
• Direct contact with IPA providers.
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Utilization review coordinator example responsibilities.

• Initial triage of members, administrative intake of members and managing the admission/discharge information post-notification.
• Identify and access Medicare entitlement benefits for those patients who meet eligibility requirements both prior to admission and during concurrent review.
• Include inpatient/outpatient acute setting, SNF, DME.
• Maintain a preventative maintenance schedule on all HVAC equipment.
• Coordinate transfers to SNF, ICF, and residential care.
• Assess patient medical needs using nationally recognize criteria sets such as InterQual.
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