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UTILIZATION REVIEW COORDINATOR
- Evolving Occupation
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| Standard Occupational Classification (SOC) Health Professional and Technicians, NEC 29-9099 |
| OES Health Professionals/Paraprofessionals, NEC 32999 |
| Utilization review coordinators are generally nurses who assess the extent to which medical services are provided in compliance with the standards set by the insurance company. They review patients' hospital records and cross-reference the records with medical insurance databases and software systems to ensure that proper cost-effective treatment was provided. They report overpayments, underpayments, and other irregularities. They also compile data to be used as evidence in claims that require litigation. |
| TASKS - 1) Provides health care, first aid, and immunization in facilities such as schools, hospitals, and industry. 2) Observes patient's skin color, dilation of pupils, and computerized equipment to monitor vital signs. 3) Records patient's medical information and vital signs. 4) Administers local, inhalation, intravenous, and other anesthetics. 5) Prepares patients for and assists with examinations. 6) Orders, interprets, and evaluates diagnostic tests to identify and assess patient's condition. 7) Prepares rooms, sterile instruments, equipment and supplies, and hands items to surgeon. |
| WORKPLACE COMPETENCIES - Utilization review coordinators should be confident in communicating with a wide range of people. They should be tactful and able to deal with difficult clients. They should also be able to work well under pressure, be self-motivated, disciplined, well-organised and accurate. |
| The following lists the KSA's for Registered Nurses (O*NET) 29-1111.00 |
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KNOWLEDGE
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Medicine and Dentistry - Knowledge of the information and techniques
needed to diagnose and treat injuries, diseases, and deformities. Biology - Knowledge of plant and animal living tissue, cells, organisms, and entities, including their functions, interdependencies, and interactions with each other and the environment Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services including needs assessment techniques, quality service standards, alternative delivery systems, and customer satisfaction evaluation techniques Chemistry - Knowledge of the composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. Therapy and Counseling - Knowledge of information and techniques needed to rehabilitate physical and mental ailments and to provide career guidance including alternative treatments, rehabilitation equipment and its proper use, and methods to evaluate treatment effects |
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SKILLS
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Speaking - Talking to others to effectively convey information Service Orientation - Actively looking for ways to help people Reading Comprehension - Understanding written sentences and paragraphs in work related documents Social Perceptiveness - Being aware of others' reactions and understanding why they react the way they do Judgment and Decision - Making Weighing the relative costs and benefits of a potential action Critical Thinking - Using logic and analysis to identify the strengths and weaknesses of different approaches |
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ABILITIES
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Oral Expression - The ability to communicate information and ideas
in speaking so others will understand Oral Comprehension - The ability to understand information and ideas presented through spoken words and sentences Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong, basically recognizing problems. Written Comprehension - The ability to read and understand information and ideas presented in writing Written Expression - The ability to communicate information and ideas in writing so others will understand |
| EDUCATION AND TRAINING REQUIREMENTS - These occupations usually require an Associate degree in nursing and some work experience as a practicing nurse. Knowledge of relational databases and statistical software is also helpful. CIP - 52.0803, 51.1600 |
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WAGE ESTIMATES - Based on the Texas 2000 Occupational Employment Statistics for a Health Professional and Technicians, NEC, the Annual Wage was $28,290 and the Median Wage was $12.28 per hour. (Source: Texas Workforce Commission/Labor Market Information Department) |
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OUTLOOK - In 1998 there were 37,750 Health Professionals/Paraprofessionals, NEC employed in Texas. The projected growth rate is 31.5%. The number of openings through 2008 is projected to be 2,125 (growth - 1,190, replacement - 935) per year. (Source: TWC/LMI) |
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INDUSTRY - Finance and Insurance |