... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
... chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of ...
Director, Group Home Services
Columbus, IN · On-site
$22/hr
Provide leadership and vision for the staff with a goal of maximizing utilization and increasing ... Review required internal investigations for assigned divisions. Make recommendations for policy ...
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Director, Group Home Services
Columbus, IN · On-site
$22/hr
Provide leadership and vision for the staff with a goal of maximizing utilization and increasing ... Review required internal investigations for assigned divisions. Make recommendations for policy ...
Provide leadership and vision for the staff with a goal of maximizing utilization and increasing ... Review required internal investigations for assigned divisions. Make recommendations for policy ...
Provide leadership and vision for the staff with a goal of maximizing utilization and increasing ... Review required internal investigations for assigned divisions. Make recommendations for policy ...
Director, Group Home Services
Columbus, IN · On-site
$22/hr
Provide leadership and vision for the staff with a goal of maximizing utilization and increasing ... Review required internal investigations for assigned divisions. Make recommendations for policy ...
Director, Group Home Services
Columbus, IN · On-site
$22/hr
Provide leadership and vision for the staff with a goal of maximizing utilization and increasing ... Review required internal investigations for assigned divisions. Make recommendations for policy ...
PRN Occupational Therapist (OT)
Terre Haute, IN · On-site
$38.25 - $50.50/hr
Medical
Dental
Vision
Life
Retirement
PTO
... equipment utilization. * Must demonstrate knowledge of state and federal accreditation ... Review medical chart and screen prior to completing evaluation to determine patients need for ...
PRN Occupational Therapist (OT)
Terre Haute, IN · On-site
$38.25 - $50.50/hr
Medical
Dental
Vision
Life
Retirement
PTO
... equipment utilization. * Must demonstrate knowledge of state and federal accreditation ... Review medical chart and screen prior to completing evaluation to determine patients need for ...
PRN Occupational Therapist (OT)
$38.25 - $50.50/hr
Medical
Dental
Vision
Life
Retirement
PTO
... equipment utilization. * Must demonstrate knowledge of state and federal accreditation ... Review medical chart and screen prior to completing evaluation to determine patients need for ...
PRN Occupational Therapist (OT)
$38.25 - $50.50/hr
Medical
Dental
Vision
Life
Retirement
PTO
... equipment utilization. * Must demonstrate knowledge of state and federal accreditation ... Review medical chart and screen prior to completing evaluation to determine patients need for ...
Clinical chart review and data abstraction experience required. * Quality improvement or patient ... Monitor quality, patient safety, throughput, utilization, and access metrics across pediatric ...
Clinical chart review and data abstraction experience required. * Quality improvement or patient ... Monitor quality, patient safety, throughput, utilization, and access metrics across pediatric ...
Pediatric Data Specialist
Fort Wayne, IN · On-site
Clinical chart review and data abstraction experience required. * Quality improvement or patient ... Monitor quality, patient safety, throughput, utilization, and access metrics across pediatric ...
Pediatric Data Specialist
Fort Wayne, IN · On-site
Clinical chart review and data abstraction experience required. * Quality improvement or patient ... Monitor quality, patient safety, throughput, utilization, and access metrics across pediatric ...
Clinical chart review and data abstraction experience required. * Quality improvement or patient ... Monitor quality, patient safety, throughput, utilization, and access metrics across pediatric ...
Clinical chart review and data abstraction experience required. * Quality improvement or patient ... Monitor quality, patient safety, throughput, utilization, and access metrics across pediatric ...
Family Practice - Without OB Physician
Indianapolis, IN · On-site
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Family Practice - Without OB Physician
Indianapolis, IN · On-site
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Physician Internal Medicine - Competitive Salary
Indianapolis, IN · On-site
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Physician Internal Medicine - Competitive Salary
Indianapolis, IN · On-site
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Internal Medicine Physician
Indianapolis, IN · On-site
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Internal Medicine Physician
Indianapolis, IN · On-site
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Physician Family Practice-Without OB - Competitive Salary
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Physician Family Practice-Without OB - Competitive Salary
Medical
Dental
Vision
Retirement
PTO
... utilization management, and quality improvement tools and processes in the market * Clinical oversight and development of APPs on effectively managing high-risk patients, including chart reviews ...
Chart Utilization Review information
What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?
To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.
What is chart utilization review?
Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.
What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?
Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.
What is the difference between Chart Utilization Review vs Chart Review Specialist?
| Aspect | Chart Utilization Review | Chart Review Specialist |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications | Often requires medical or coding certifications |
| Work Environment | Healthcare facilities, insurance companies, utilization management teams | Medical offices, insurance companies, coding firms |
| Employer & Industry | Hospitals, insurance providers, healthcare organizations | Medical billing companies, insurance firms, healthcare providers |
| Primary Focus | Assessing medical necessity and appropriateness of services | Reviewing medical records for coding accuracy and completeness |
While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.
What are popular job titles related to Chart Utilization Review jobs in Indiana?
For Chart Utilization Review jobs in Indiana, the most frequently searched job titles are:
- Utilization Management
- No Experience Utilization Management Nurse
- Registered Nurse Utilization Review
- Manager Utilization Management
- Per Diem Utilization Review Nurse
- Remote Utilization Review Nurse
- Utilization Review Nurse
- Night Utilization Review Nurse
- Part Time Utilization Review Nurse
- No Experience Utilization Review Nurse
What job categories do people searching Chart Utilization Review jobs in Indiana look for?
The top searched job categories for Chart Utilization Review jobs in Indiana are:
- Milliman
- Remote Navihealth Utilization Review
- Authorization Utilization Review
- Lpn Utilization Review Work From Home
- Utilization Review Case Manager
- Discharge Planner Utilization Review
- Remote Aetna Utilization Review
- Remote Rn Utilization Review Nurse
- Psychiatric Utilization Review
- Seasonal Remote Utilization Review
Full-time
Re-posted 27 days ago
Job description
OverviewCase Manager is responsible for chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of resources and optimal outcomes. Responsible for coordinating the patient's plan of care from admission to discharge and or transfer to another level of care.ResponsibilitiesApplies to individual case, through chart review, third payer regulations that govern admissions, continued stay, and discharge, i.e. IS/SI. Collects data related to clinical improvement initiatives for the purpose of developing action plans. Conducts concurrent chart reviews to assure complete and accurate medical records documentation. Coordinates the patient's plan of care with all members of the health care team including the patient, caregiver, and or family members and case management. Demonstrates proficiency in patient assessment and documentation. Interviews and assesses patients to determine potential barriers to timely discharge/transfer to another level of care. Provides all payers with accurate, updated information. Obtains covered stay certification and prior authorization as appropriate. Refers cases when appropriate to physician advisor for medical necessity, continued stay, physician education and appropriate level of care. Refers to Social Services when appropriate. Ensures discharge planning to the appropriate level of care, sub-acute, hospital units, and outpatient services. Supports hospital CQI programs by participation on relevant teams. Performs other duties as needed and/or assigned. Qualifications
PRINCIPAL DUTIES AND RESPONSIBILITIES (*Essential Functions)
JOB SPECIFICATIONS (Minimum Requirements)KNOWLEDGE, SKILLS, AND ABILITIES
- Knowledge of appropriate and timely return transition levels of care.
- Knowledge of CARF, Regulatory Agencies and State Board of Health, Long Term Care, Acute Care and Ambulatory Care Standards.
- Demonstrates excellent interpersonal and problem-solving skills.
- Demonstrates self-directed, goal orientated and customer service.
- Excellent organizational and prioritization skills to meet deadlines.
- Capable of functioning effectively across service lines.
- Ability to assess and interpret data about the patients status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient.
- Ability to independently perform comprehensive chart review with subsequent abstraction or relevant information including interpretation of lab results, EKG and other medical tests.
- Ability to communicate effectively both verbally and in writing.
- Ability to provide compassionate patient care orientated with an effort for timeliness and accuracy in the delivery of service.
- Ability to respond positively to the needs of patients and family. Addresses customer concerns in a private, respectful and calm manner.
EDUCATION
All post high school education must have been obtained from a recognized College or University.
- Associates Nursing Required
- Bachelors Nursing Preferred
EXPERIENCE
- 3 years Acute Care experience Required
LICENSE/CERTIFICATION
- Active Licensed Registered Nurse
- Basic Life Support Certification
STANDARDS OF BEHAVIORMeets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCEDemonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.
Employment Type: FULL_TIME
About Methodist Hospitals
Sourced by ZipRecruiter
Methodist Hospitals is a reputable institution in the healthcare and medical industry with its base in Gary, Indiana, United States. A trusted name in comprehensive medical services, the organization is primarily known for its robust offering in the fields of emergency and acute medical care, tracking back its foundational roots to the year 1923. Catholic nun Sister Gesuina set up the hospital with the sole mission of providing affordable healthcare services to the residents of Gary. Today, their mission stays true to promoting health, healing, and well-being in the communities they serve, encompassing a diverse representation of races, ethnicities, genders, ages, religions, abilities, and sexual orientations.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Gary, IN, US
Year founded
1923