A utilization review coordinator is a medical professional whose job it is to ensure that processes in medical institutions adhere to regulations and quality standards. Nurses or those with formal academic training in a field related to health are the most common professionals in this field. Review coordinators in many areas are also required to complete additional training and pass a series of proficiency exams. Professionals with training and experience in a more specific field are required for some review coordinator positions. A utilization review coordinator in a mental health facility, for example, may be required to have experience or certification in a field directly related to mental health or social work.
A utilization review coordinator is someone who keeps track of the steps of medical processes. For example, according to relevant regulations, a professional in this field might first create an outline of steps that should be included in a specific medical process. In the United States, for example, such a professional must first be familiar with federal and state regulations. He or she then observes procedures on patients to ensure that they follow protocol.
It is also common for a review coordinator to serve as a patient treatment adviser or coordinator. He or she might, for example, look into medical procedures, insurance, and the length of an inpatient stay. Data specific to a patient’s medical history, as well as data illustrating state or federal treatment norms, may be used by a coordinator. He or she may then meet with top medical experts to discuss medical treatment options.
A utilization review coordinator can also help a medical facility improve its procedures. As a coordinator oversees processes, he or she may make notes about ways to make them more efficient or effective for patients. Utilization review boards are found in almost every institution. A coordinator frequently meets with members of a board of directors to provide feedback and valuable suggestions.
Utilization review coordinators frequently examine payment and paperwork processes as well. Before submitting paperwork to insurance companies or patients, these professionals may review it. They may also communicate with and consult with parties who are in charge of paying a medical institution. Review coordinators may meet and consult with in-house financial counselors at hospitals.