The Utilization Management Care Coordinator is a professional RN based in the Emergency Department whose area of responsibility is to coordinate communication and care between physicians, Patient Access Services and Utilization Review to assure appropriate admission status assignments. The UM Care Coordinator collaborates with physicians and reviews patients for appropriateness of care including medical necessity and to identify the correct level of care, e.g. acute inpatient, observation or skilled care.
Current Georgia nursing license
Minimum 3 years acute care clinical nursing experience.
BSN preferred, Prior UR experience with knowledge of InterQual or other payor experience, and ICD/CPT knowledge, or coding experience preferred
MCG Health System - 13 months ago