UTILIZATION REVIEW Skillsheet

ADMISSION REVIEW
InterQual Criteria
                             
DCP Referrals/Rounds
                             
Education of Medical and Nursing Staff
                             
CONCURRENT REVIEW
Appropriate Level of Care
                             
Documentation of Medical Necessity
                             
Variance Tracking/Reporting
                             
MANAGEMENT OF RESOURCES
Timeliness of Service, Sequencing
                             
Over/Under Utilization of Resources
                             
Payor Authorization
                             
OTHER
Critical Thinking Skills
                             
Problem-Solving Skills
                             
Advocacy
                             
Ethical and Legal Issues
                             
Financial Classifications
                             
Paperwork
                             
Professional Development
                             
PAYOR CONSIDERATIONS
Pre-Authorization/Concurrent Approval of Days
                             
Negotiation of Payment for Services
                             
Appeals
                             
Insurance Reviews