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What Does a Utilization Review Coordinator Do?

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  • Written By: D. Nelson
  • Edited By: M. C. Hughes
  • Last Modified Date: 24 September 2014
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A utilization review coordinator is a medical professional responsible for making sure that processes which occur in medical institutions are compliant with regulations and standards of quality. Professionals in this field tend to be nurses or to have formal academic training in a field related to the health field. In many regions, utilization review coordinators must also go through special training and pass a number of proficiency exams. Some utilization review coordinator positions require that professionals have training and experience within a more specific field. An individual who would like to act as a utilization review coordinator in a mental health facility, for example, might be expected to have experience or certification in a field directly related to mental health or social work.

Commonly, a utilization review coordinator tracks the steps of medical processes. For example, a professional in this field first might create an outline of steps that should be included in a particular medical process according to relevant regulations. In the United States, for example, this kind of professional first must be familiar with regulations at the federal and state level. He or she then observes processes performed on patients to ensure that they match guidelines.

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It also is common for a utilization review coordinator to act as an adviser or coordinator on patient treatment. For example, he or she might review issues related to medical processes, insurance, and length of inpatient stay. A coordinator also might use data related specifically to a patient's medical history, as well as data that illustrates state or federal norms for treatment. He or she might then meet with top medical professionals and discuss options for medical treatment.

A utilization review coordinator also helps to improve practices at a medical facility. As a coordinator oversees processes, he or she might make notes regarding areas where processes can be more efficient or more effective for patients. Most institutions have utilization review boards. A coordinator commonly meets with professionals on a board to provide feedback and make valuable suggestions.

Payment and paperwork processes also are commonly reviewed by utilization review coordinators. These professionals might look over paperwork before it is submitted to insurance companies or patients. They also might communicate with and consult parties who are responsible for making payments to a medical institution. Hospitals often have in-house financial counselors with whom review coordinators might meet and consult.

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