About the role

Aplyr's Quick Take

The Utilization Review Coordinator is responsible for assessing patient admissions for medical necessity and appropriateness of care settings. This role involves reviewing cases, communicating with healthcare teams, and educating staff and patients, primarily working from home during standard business hours.

Good fit

Ideal candidates have an RN license and at least three years of nursing experience, with a preference for those who have worked in utilization or case management. A detail-oriented approach and strong communication skills are essential for success in this role.

Worth noting

The position is fully remote, which can be a plus for work-life balance. However, the role requires a significant amount of communication with various stakeholders, which may not suit everyone.

Work From Home

Work From Home Work From Home, Indiana 46544

The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for appropriateness of setting and utilization.

WHO WE ARE

With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

WHAT YOU CAN EXPECT

Schedule: Monday - Friday, 8am - 4:30pm EST
Perform concurrent reviews for appropriateness of utilization to optimize clinical and financial outcomes.
Communicate with physicians, patients, members of the Healthcare team, Coordinated Business Office staff, Denial Management staff, and third-party payors to justify the admission or continued stay.
Notify appropriate staff members of any admission, service, length of stay, lack of medical necessity criteria, as well as denials/appeals and issuing of letters to patients.
Provide Physician, Patient, Family, Staff and Student education.
Act as a resource person for the case management department regarding payer rules, regulations, policies and procedures, and utilization issues.
Perform admission necessity screening using criteria as established by the various federal, state and private sector programs.

QUALIFICATIONS

Associate degree in nursing/patient care required
Bachelor's Degree in nursing/patient care preferred
Registered Nurse (RN - Indiana licensure) required
3 years of nursing/patient care experience required
2 years of Utilization or Case Management experience preferred

TRAVEL IS REQUIRED:

Never or Rarely

JOB RANGE:

Utilization Review Coordinator $56971.20-$84749.60

INCENTIVE:

Not Applicable

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Aplyr's read

Franciscan Health is a multi-state healthcare system known for its comprehensive services and strong emphasis on patient care, attracting dedicated medical professionals.
Synthesized from recent postings & public sources

What's promising

•Franciscan Health offers a wide range of specialized medical services, enhancing career opportunities for healthcare professionals.
•The organization is known for its commitment to patient-centered care, a key attraction for compassionate medical staff.
•Franciscan Health's multi-state presence provides diverse work environments and potential for career mobility.

What to watch

•The healthcare industry faces ongoing regulatory changes, which can impact job stability and operational procedures.
•Limited public information about specific employee satisfaction and internal culture at Franciscan Health.
•Potential high-stress environment due to the demanding nature of healthcare roles and patient care responsibilities.

Why Franciscan Health

•Franciscan Health's integration of hospitals and outpatient facilities offers varied clinical settings under one system.
•The organization emphasizes faith-based care, appealing to professionals aligned with its values.
•Franciscan Health's regional reach allows it to serve diverse communities, offering unique patient interaction experiences.

Aplyr’s read is generated by AI from public sources. Was it useful?

About Franciscan Health

Franciscan Health

franciscanhealth.org

View company

Franciscan Health is a comprehensive healthcare system providing a range of medical services including hospitals, outpatient facilities, and specialized care across several states.