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Coordinates and supervises all phases of Utilization Review and Social Services. Plans and directs the operational activities of the Utilization Review and Social Services Departments, assuming responsibilities for quality and productivity of utilization review and discharge planning.: Coordinates, facilitates, and integrates high quality, cost-effective care delivered to individuals or groups of patients across an episode of illness or throughout the continuum of care. Assesses, plans, intervenes, and evaluates clinical outcomes. Performs concurrent review of patients' medical records for medical necessity, appropriateness of setting, assessment of the quality of medical care, and the tracking/trending of these activities. Directs the patient complaint and quality management program. Monitors utilization activities and tracks and reports data. Maintains relationships with physicians, department heads, administrators, and clinical coordinators to support intra-departmental goals. Supervises staff.

Utilization Review/Quality Assurance Director

Serves as an information coordinator for the hospital-wide quality assurance program. Directs development of monitors, including generic screens, to assess the quality of care provided to patients.: Supports the overall quality assurance reporting system to assure that information is being channeled to appropriate oversight committees. Provides consultation to health care providers as needed to facilitate problem-focused studies of patient care, which may include advice and support for clinical/legal implications of quality issues. May assume Risk Management responsibilities. May supervise several employees.

Utilization Review Manager

Manages the utilization review function to ensure accurate and timely prior authorization of designated healthcare services, concurrent review, and retrospective review activity. Performs regular data analysis of hospital census, authorization information and medical cost reports to identify variances and root causes so that areas of focus may be identified and resources may be appropriately deployed.: Manages the utilization review function to ensure accurate and timely prior authorization of designated healthcare services, concurrent review, and retrospective review activity. Manages a department responsible for the determination of medical necessity and appropriateness of care based on predetermined criteria and/or guidelines. Plans, organizes, implements and evaluates departmental outcomes. Performs regular data analysis of hospital census, authorization information and medical cost reports to identify variances and root causes so that areas of focus may be identified and resources may be appropriately deployed. Prepares and manages the departmental budget. Hires, develops and motivates a qualified utilization review department staff. Ensures that benefits and policies are properly interpreted and that care is rendered in the most appropriate site of service with a focus on quality care and cost efficient outcomes. Assures timely response to provider requests for services per department standards. Conducts regular clinical reviews for utilization management activities, based on guidelines and standards for patients in a variety of settings. A Registered Nurse with clinical and managed care experience is typically required for this position.

Real Estate Utilization Officer

Coordinates property procurement and maintenance activities, and negotiates with representatives to effect property transfers and sales, rental, and leasing contracts for government agency: reviews property-related data, such as inventories, budgets, planning reports, vendor brochures, and excess property and property request reports, to obtain information on property status, needs, and availability. Writes, fills out, and reviews bids, contract specifications, purchase orders and estimates, and transfer forms to effect property transactions. Contacts vendors and potential users, and inspects and inventories acquired and transferred property through visits to government installations and vendor sites. Negotiates and confers with administrators, vendors, or users to effect agreement on property transfer details, such as price, model, packaging, transportation, land boundaries, or building layout. Authorizes expenditures within specified limits for purchases of supplies and equipment, equipment repair and maintenance, and alterations to premises. Fills government agency or other qualifying organization requests from surplus inventories, considering factors such as donation criteria, actual needs, and justification. Prepares plans, standards, and specifications for building and equipment maintenance, repair, and inspection. May be designated according to property involved as real-estate-utilization officer; state-surplus-commodity-and-property representative.

Property Utilization Officer

Utilization Review/Quality Assurance Coordinator

Interprets and implements quality assurance standards in clinical area or hospital to ensure quality care to patients. Ensures appropriate care is provided to patients. Reviews quality assurance standards, studies existing policies and procedures, and interviews personnel and patients to evaluate effectiveness of quality assurance program. May report to Quality Assurance Head Hospital or a similar high-level position. Position typically requires a bachelor's degree in the field of nursing.: Serves as a professional resource to nursing staff. Writes quality assurance policies and procedures. Reviews and evaluates patients' medical records, applying quality assurance criteria. Selects specific topics for review, such as problem procedures, drugs, high volume cases, high risk cases, or other factors. Compiles statistical data and writes narrative reports summarizing quality assurance findings. May review patient records, applying utilization review criteria, to determine need for admission and continued stay in hospital. May oversee personnel engaged in quality assurance review of medical records.

Utilization Review Supervisor

Plans, organizes, and supervises, under general direction, the activities of the Utilization Review unit of a hospital. Ensures compliance with reimbursement rules of third-party payers. Performs the more complex utilization review work. Monitors and ensures hospital compliance with Medic-Cal, Medicare, and insurance reimbursement policies, the maintenance of patient care quality, and the maximizing of reimbursements for services provided. Reports to the Hospital Quality Assurance Manager.: Plans, organizes, and supervises the staff of the Utilization Review unit. Reviews and analyzes government and accrediting agency standards governing admissions, treatment, and continued stay of patients. Develops policies and procedures for adherence to governmental and accrediting agency standards. Coordinates the work of the Utilization Review staff with medical staff to ensure appropriate and timely patient care action and to maximize reimbursement. Analyzes individual patient records to determine appropriateness of admission. Reviews patient treatment plans for adherence to established criteria and standards. Refers cases that fail to meet criteria to the Patient Care Review Committee for review and course of action. Conducts studies and prepares reports for the review committee, medical staff, and administration. Serves as review committee liaison with other committees to coordinate formulation of policy and procedures. Explains procedures and documentation requirements to medical staff, managers, and other hospital personnel. Interviews, selects, trains, and evaluates Utilization Review staff.

Superintendent Labor Utilization

Directs and coordinates activities concerned with utilization and work of labor pool in industrial establishment: inspects plant buildings, structures, and grounds and reviews human resource requests from other departments for workers to perform such work as cleaning tanks, digging ditches, or assisting craft workers, in order to plan labor pool utilization and establish priorities, projects, and schedules. Confers with subordinate supervisory personnel on status of on-going projects and number of workers required in order to determine allocation and assignment of human resources in labor pool. Assigns supervisory personnel and workers to perform work requested, complete on-going projects, or to assist craft workers, considering such factors as priority of project or work, type of work, and available human resources in labor pool. Inspects projects to ensure work performed meets standards and that workers are observing established safety rules and regulations for type of work being performed. Reassigns workers to meet unforeseen emergencies or work requests. Prepares activity reports on utilization of labor pool human resources, status of projects, and workers assigned work with other departments.

Utilization Review Coordinator

Analyzes and evaluates patients' medical records, charts, computer printouts, and support documents to ensure criteria for admission to health-care facility, treatment, and length of stay are met, and to ensure cost effective utilization of resources, according to established criteria: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients. Reviews admission records, medical records, charts, and supporting documentation to establish reason for admission, diagnosis, and length of stay. Approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards. Determines necessity, cost effectiveness, and documentation of treatment and care provided, utilizing coding and classification manuals, insurance, governmental, and accrediting agency regulations and standards to determine that established criteria for admission and care have been met. Reviews pre-certification request and application for admission, calculates estimated cost of prescribed medical treatment, prepares required paperwork, and approves admission based on predetermined criteria for pre-hospitalization request from health providers or insurance subscribers. Monitors health care treatment provided to patient during patient's stay in medical facility and compares inpatient medical records to established criteria and confers with medical personnel and other professional staff to determine legitimacy of treatment and length of stay, to ensure services are within prescribed limitations, to ensure availability of future benefits, and to guard against potentially abused medical procedures and diagnoses. Retrieves medical data from medical records, charts, and computer, and abstracts required data from records to use in compiling reports and for statistical purposes. Acts as liaison for insurance provider, contractors, and subscribers to explain and interpret provisions of contractual agreements and health benefits and to process complaints. May assist review committee to plan and conduct federally mandated quality assurance reviews. May direct activities of utilization review staff. May conduct telephone reviews to ensure that patient admission to provider facility meets established criteria. May interview patient to obtain medical history information and determine necessity of treatment.

Utilization Supervisor

Coordinates activities of merchandise-servicing department of gas or electric appliance distributors: supervises, trains, and assigns duties to workers engaged in servicing appliances, pricing, and disposition of returned merchandise and excess repair parts. Develops company policies and procedures regarding servicing of appliances and disposition of defective parts. Consults manufacturers to obtain advice on unusual service problems and to obtain service instructions and parts catalogs. May write instructions on care and use of appliances for distribution to public.

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