PURPOSE STATEMENT:

Provide administrative support to the Utilization department. 

ESSENTIAL FUNCTIONS:

Perform pre-certification and negotiate continued stay with third party payers in a professional manner.

Gather data to support case management activities, including presentation of gathered data and case notes.

Verbally present knowledge of cases and the needs of third-party payers in a timely manner. 

Assist in admissions review, concurrent reviews and discharge planning.

Assist physician in peer review by serving as information resource, gather data to support review and schedule peer review.

Keep leadership advised of status of current patients, in regard to utilization activities through timely documentation and participate in performance improvement activities.

Coordinate with clinical team for discharge planning, maintain CRM database with discharge information and follow up.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

High school diploma or equivalent required.