Job Information
State of Indiana Utilization Review Coordinator in Indianapolis, Indiana
Utilization Review Coordinator
Date Posted: May 31, 2024
Requisition ID: 444677
Location:
Indianapolis, IN, US, 46218
Work for IndianaBegin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a diverse range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the chance to make a real and measurable impact on the lives of Hoosiers across Indiana.
At the State of Indiana, we don’t just talk about diversity and inclusion—we make it our goal to create a welcoming, accessible, and equitable workplace with a workforce that is representative of Indiana's population. As a proud equal opportunity employer, reasonable accommodations may be available to enable individuals with disabilities to complete the application and interview process as well as perform the essential functions of a role.
About (Add Agency Name Here) :
(ADD STATEMENT HERE)
Role Overview:
Purpose of Position/Summary:
Responsible for ensuring the delivery of high quality, cost efficient medical outcomes for patients in need
of inpatient and/or outpatient precertification/preauthorization. Responsible for evaluating the
appropriateness of patient admissions/continued stays/discharge criteria and assign Length of Stay
(LOS) within a designated time frame. Implementation of the attending physicians’ decision of
coverage/non-coverage of Medicare A. Reviews all Medicare A cases and confers with the attending
Physicians regarding Medicare coverage of hospital stay. Oversees the issuance of Medicare A
admission, denial notices and discharge appeal rights. Submits insurance verification/pre-certification
within 24 hours of the patient's admission.
Essential Duties/Responsibilities:
• Review precertification requests for medical necessity, referring to the Medical Director those that require
additional expertise.
• Review clinical information for concurrent reviews, extending the length of stay for inpatients as appropriate.
• Establish effective rapport with other employees, professional support service staff, patients, families, and
physicians.
• Use effective relationship management, coordination of services, resource management, education, patient
advocacy, and related interventions to:
o Promote improved quality of care and/or life.
o Promote cost effective medical outcomes.
o Promote decreased length of hospital stay when appropriate.
o Prevent patient care complications when possible.
o Provide continuity of care.
o Ensure the delivery of appropriate level of care to patients.
• Provide appropriate consultation and referral to social workers.
• Identify appropriate alternative and other non-traditional resources and demonstrate creativity in managing
each case by utilizing all available resources.
• Maintain accurate records of all interventions and provide timely verbal and written reports to the treatment
team.
• Development of the annual utilization review plan.
• Serve as the chairperson for the utilization review committee.
• Prepare quarterly utilization review reports.
• Participate in the hospital quality improvement initiatives.
• Clinical record review and audit.
• Completion of discharge PowerForms in Cerner as a requirement of the ORXY measures.
• Serve as CPR and Bridge Building instructor.
• Other duties as assigned.
This document is used to provide
a basic description of essential
duties and other work elements.
Job Requirements:
• Bachelor of Science degree in Nursing from an accredited college or university.
• Current licensure as a Registered Nurse (RN) in the State of Indiana.
• Two years prior experience with utilization management.
• Demonstrated competence in quality assurance and case management outcomes.
• Excellent relationship management skills.
• Strong organizational, task prioritization, and delegation skills.
• CPR Certification.
• Bridge Building de-escalation training.
Supervisory Responsibilities/Direct Reports:
This position reports directly to the Quality Director and currently has no supervisory responsibility.
Difficulty of Work:
Work is of high complexity requiring the application of specialized knowledge to complex laws,
regulations, and rules regarding Medicare/Medicaid coverage.
Responsibility:
Responsible for ensuring the delivery of high quality, cost efficient medical outcomes for patients in need of
inpatient and/or outpatient precertification/preauthorization. Responsible for evaluating the appropriateness
of patient admissions/continued stays/discharge criteria and assign Length of Stay (LOS) within a
designated time frame.
Physical Effort:
Frequent sitting, lifting, bending, stooping, walking, and occasional standing up to 7.5 hours. Strength
and physical dexterity may be required to manage patients’ behaviors.
Working Conditions:
Require sitting for an extended period in an office space. The work schedule is 8am to 4pm Monday
through Friday.
Salary Statement:
The salary for this position traditionally starts at $0.00 but may be commensurate with education or work experience.
A Day in the Life:
The essential functions of this role are as follows:
Prioritize and organize the daily care of patients.
Make patient care assignments and assist in developing treatment plans in collaboration with other clinical staff.
Provide ongoing assessment and documentation of the patients' physical and psychosocial status from admission to discharge.
Direct support staff to coordinate the workflow on the unit and communicate problems to unit supervisors.
Administer medications and treatments according to facility’s policies and procedures.
Develop and implement nursing care plans for nursing diagnosis or treatment plan changes.
Complete medication administration supervision monitors and clinical observation notes for support staff.
Completes required documentation of nursing notes, transfer forms and other records.
Educate patients and family members regarding medication, procedures and treatment goals and objectives.
Repond and intervene to emergency situations and agitated patients.
Provide orientation and support to staff to the unit.
Responsible for ensuring the proper safety and infection control standards are met for the unit.
The job profile is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
What You'll Need for Success:
You must meet the following requirements to be considered for employment:
Associate degree in Nursing from an accredited college.
License to practice nursing in the State of Indiana as a Registered Nurse.
Must hold and maintain a CPR certification.
Must stay current with behavioral intervention training.
Proficiency in computer skills and ability to learn other programs used in maintaining electronic medical records.
Good interpersonal skills, good verbal, and written communication skills.
Ability to understand and apply medical and facility terminology.
Ability to use MS Office applications and electronic patient records.
Ability to serve as a patient advocate.
Knowledge of and the ability to interpret nursing and facility policies and procedures.
Additional knowledge and/or ability may be required based on the population the facility serves such as: children, adolescents, geriatrics, etc.
Supervisory Responsibilities/Direct Reports:
This role may be utilized in a supervisory capacity based on agency needs.
Benefits of Employment with the State of Indiana:
The State of Indiana offers a comprehensive benefit package for full-time employees which includes:
Three (3) medical plan options (including RX coverage) as well as vision and dental plans
Wellness Rewards Program: Complete wellness activities to earn gift card rewards
Health savings account, which includes bi-weekly state contribution
Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities
Deferred compensation 457B account (similar to 401k plan) with employer match
Two (2) fully-funded pension plan options
A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:
150 hours of paid new parent leave
Up to 15 hours of paid community service leave
Combined 180 hours of paid vacation, personal, and sick leave time off
12 paid holidays, 14 on election years
Education Reimbursement Program
Group life insurance
Referral Bonus program
Employee assistance program that allows for covered behavioral health visits
Qualified employer for the Public Service Loan Forgiveness Program
Free Parking for most positions
Free LinkedIn Learning access
Equal Employment Opportunity:
The State of Indiana is an Equal Opportunity Employer and is committed to recruiting, selecting, developing, and promoting employees based on individual ability and job performance. Our policy is to provide equal employment opportunity to all people in all aspects of employer-employee relations without discrimination because of race, color, creed, religion, sex, national origin, ancestry, age, sexual orientation, gender identity, physical or mental disability, or veteran status. We will comply with the spirit as well as the letter of all applicable state and federal laws.
If you are a qualified individual with a disability and require reasonable accommodations to complete this application, you can request assistance by contacting the Indiana State Personnel Department at [email protected] .
The State of Indiana has established a culture that welcomes equity, inclusion, and opportunity for all employees and applicants. We encourage you to apply if you feel you have the transferrable skills to be successful in this position and we look forward to reviewing your application.
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