2nd Annual Fund Raiser

Career Center

JOB TITLE: Utilization Review / Quality Improvement Coordinator

REPORTS TO: Clinical Director

JOB SUMMARY: A professional nurse who promotes optimum delivery of care to patients by compiling and analyzing documentation for reimbursable services and patient outcomes and QI activities. Educates staff to documentation and provides supervision and coordination of utilization review personnel.

QUALIFICATIONS:

  • Knowledge, Skills, and Abilities:
    • All qualifications in Community Health Nurse job description.
    • Thorough understanding of the Conditions of Participation and insurance guidelines.
    • Supervisory experience.
    • Experience in Utilization Review activities.
    • Experience in Quality Improvement benchmark activities for Home Care.
    • Knowledge of PPS, OASIS, medical terminology, insurance, and coding.
    • Excellent problem solving skills and organization.
    • Excellent verbal, written communication skills.
    • Computer knowledge preferred.
    • Ability to maintain confidentiality.
    • Good documentation skills.
    • Ability to communicate with a variety of disciplines in a professional manner.
  • Education and Experience:
    • Graduate from an accredited school of nursing, preferably B.S.N.
    • Current Michigan license to practice nursing.
    • One year work experience in Medical / Surgical Nursing.
    • Minimum of two years experience in Community Health Nursing.