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DOT Code: 079.267-010

Industry: medical ser.

Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients. Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards. Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay. Abstracts data from records and maintains statistics. Determines patient review dates according to established diagnostic criteria. May assist review committee in planning and holding federally mandated quality assurance reviews. May supervise and coordinate activities of utilization review staff.

GOE: 11.07.02 STRENGTH: L GED: R5 M4 L5 SVP: 7 DLU: 89