ESSENTIAL FUNCTIONS:

Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient’s provider benefits for their needs. 

Responsible for the concurrent and retrospective reviews for all patients. 

Act as a liaison between Medicaid reviewers/gatekeepers and the staff completing required paperwork to facilitate the Utilization Review process. 

Work with physicians, therapist and nursing staff to provide optimal review based on patient needs. 

Work with ancillary services in order to prevent delays in services. 

May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues. 

Provide oversight and direction to utilization staff.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.