Sheridan Community Hospital · 2 months ago
Utilization Management Coordinator- Full Time
Sheridan, MI
Full-time
Onsite
Mid Level
3+ years expSheridan Community Hospital is seeking a dedicated Utilization Management Coordinator (RN) to join their team. This role is responsible for coordinating and evaluating the medical necessity, appropriateness, and efficiency of healthcare services for patients, ensuring compliance with hospital policies and payer requirements.
Health CareHealth DiagnosticsMedicalNursing and Residential CareRehabilitation
Responsibilities
Review patient admissions, continued stays, and discharges for medical necessity and level of care
Collaborate with physicians, nursing staff, case management, and payers to ensure timely and appropriate care delivery
Perform utilization review and documentation in accordance with hospital policies and payer guidelines
Serve as a resource for staff regarding clinical documentation, regulatory standards, and medical necessity criteria
Participate in quality improvement initiatives related to utilization and care coordination
Maintain current knowledge of SI/IS criteria (InterQual) and payer requirements
Qualification
Required
Current RN license in the state of Michigan
Bachelor's degree in Nursing required
Minimum of 3 years of clinical nursing experience
Minimum of 1 year experience in Utilization Management, Clinical Documentation Improvement, and Discharge Planning
Strong analytical, communication, and critical-thinking skills
Proficiency with electronic medical records and documentation systems
Preferred
Master's degree preferred
Company
Sheridan Community Hospital
Sheridan Community Hospital offers diagnostic imaging, laboratory, physical therapy, surgical, nursing care, and rehabilitation services.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Lili Petricevic
Chief Executive Officer
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