Job Description
Responsibilities The Utilization Review Coordinator (URC) is responsible for initial clinical review. URC may approve requests for admissions, procedures, and services that meet clinical review criteria, but must refer requests that do not meet clinical review criteria to peer clinical review for certification or non-certification.
Responsibilities and essential duties:
Visits the hospital facilities or receives the documentation via fax and perform the initial review of the clinical information. Discuss the cases with the psychiatrists, psychologists, or social worker as appropriate to discuss medical necessity criteria for authorizations. Maintains the daily census of the assigned facilities. Responsible for making sure that the peer-to-peer discussion takes place. Issues the services authorizations after the review is completed. Maintains ...