Job Description:

• 1) Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.

• 2) Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards.

• 3) Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.

• 4) Abstracts data from records and maintains statistics.

• 5) Determines patient review dates according to established diagnostic criteria.

• 6) May assist review committee in planning and holding federally mandated quality assurance reviews.

• 7) May supervise and coordinate activities of utilization review staff.