Utilization Documentation Specialist

Functions under the direction of the Utilization Documentation Manager and Director of Case Management. Demonstrates fiscal responsibility, resource utilization, payer requirements and organizational goals. Screens medical records for admission and concurrent criteria using Inter. Qual® criteria/3M endcoder. Secures authorization/certification for services by communicating necessary and requested information with payors.

Communicates information that will impact the discharge plan to the Transitional Care Coordinator. Maintains an awareness of the business of medicine and transitional healthcare changes, including but not limited to value-based purchasing, bundled payments, accountable care organizations and the readmission reduction program.