Utilization review (UR) coordinators are responsible for ensuring that patients receive the correct types of treatments for appropriate amounts of time. Cases are reviewed based on admission appropriateness, length of stay, and planning of discharge, and it's also important that patients are truly ready for discharge when the time comes. Research must be carried out in this position, including field research, laws and regulations, and the facility’s policies. It may also be necessary to abstract data from medical records, charts, and notes, and these reviews will be carried out before, during, and after treatments.
UR coordinators must understand all medical terminology and be able to use it correctly, and this knowledge may need to be updated as time goes on. These coordinators review the work of doctors, nurses, assistants, therapists, and dieticians, and communication and reports are made with staff members, physicians, and safety coordinators within the facility. They also implement and monitor safety plans and may coordinate third-party payment authorizations.
Knowledge of reviews like RAC, KEPRO, and MAC is necessary to carry out audits, and strong verbal and written communication skills and computer skills are also important in this position. Experience in managed care or as a registered nurse is usually required by employers, and many positions require UR coordinators to have a registered nurse qualification in addition to a bachelor's or master's degree.
Utilization Review (UR) Coordinator Tasks
Resolve errors or issues with physician or advisor staff.
Audit medical record data to ensure compliance and justify treatment or length of stay.
Report and maintain documentation regarding patient continued hospitalization.