Utilization management (UM) coordinators work within the health care industry. Coordinators deal with medical appropriateness, ensuring that patients receive the right amount of treatment in line with medical standards at the right time. A utilization management coordinator also trains the nursing staff to use nursing facilities in compliance with federal, state and local guidelines.
Nursing Qualifications and Licenses
Employers prefer that UM coordinators be registered nurses. While licensing requirements vary with different states, becoming a registered nurse typically requires a bachelor's or associate degree in nursing. In some states, an approved nursing diploma may be enough. Candidates will also need to pass the NCLEX-RN licensing exam, administered by the National Council of States Board of Nursing. Employers may also require that UM coordinators be trained in assessment tools such as the Minimum Data Set (MDS) and Residential Assessment Instrument (RAI) and Residential Assessment Protocols (RAPS). Candidates are expected to remain updated on the changes within their profession, including emerging technologies and health policies.
Part of the duties of a UM coordinator includes training employees within the hospital to develop the right care plan and providing assistance, in line with the Minimum Data Set (MDS) process. A UM coordinator monitors the health and status of residents within a facility to ensure that they are being cared for properly. Employers may require that candidates create a nursing care plan that outlines the problems faced by residents, and the approach to solving each. In addition to the preparation and implementation of care procedures, the utilization management coordinator will be responsible for monitoring the performance of the hospital team to ensure compliance.
The UM coordinator performs administrative duties such as monitoring the discharge process and ensuring that clinical documentation is done accurately. She works closely with the medical professionals, and may sometimes submit reports containing updates to the Chief Clinical Officer and Corporate Office Administrator. A coordinator may provide information to families regarding the different financial Medicaid programs available to them. Candidates review nurses' notes to ensure that they are performing their duties in accordance with a care plan.
Surveys and Recommendations
As a part of their duties, utilization management coordinators sometimes participate in inspections of a hospital facility. These surveys may be done alongside an authorized government agency. Using the survey results, as well as the data available, UM coordinators may make recommendations on how the nursing service department can be improved.