Utilization Management Coordinator. A designated health care practitioner to be responsible for utilization management functions.
Utilization Management Coordinator. The Utilization Management Coordinator shall be a full-time position. This position shall be an Illinois-licensed Physician, Illinois-licensed registered nurse, or other professional as approved by the Department based on Contractor’s ability to demonstrate that the professional possesses the training and education necessary to meet the requirements for UR activities required in the Contract. This position will oversee prior authorizations and manage the inpatient certification review staff for inpatient initial, concurrent, and retrospective reviews. The review staff shall consist of RNs, Physicians, Physician assistants, or licensed practical nurses who are experienced in inpatient reviews and who operate under the direct supervision of a Registered Nurse, Physician, or Physician assistant.
Utilization Management Coordinator. Contractor shall have a full-time Utilization Management Coordinator, who shall be (i) a registered nurse licensed in Illinois, or (ii) other professional as approved by the Department based on Contractor’s demonstration that the professional possesses the training and education necessary to meet the requirements for utilization review activities required in the Contract. The Utilization Management Coordinator will manage the pre-authorization and Referral functions, and inpatient certification review staff for inpatient initial, concurrent and retrospective reviews.
