- Knoxville, Tennessee, United States
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
Responsibilities
- Act as liaison between managed care organizations and the facility professional clinical staff
- Conduct reviews of insurance plans or other managed care organizations and coordinate communication concerning reimbursement requirements
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay
- Gather and develop statistical and narrative information to report on utilization, non-certified days, discharges and quality of services
- Conduct quality reviews for medical necessity and services provided
Requirements
- High school diploma or equivalent