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Utilization Review
Phone: (970) 564-2352
e-mail: rvandover@swhealth.orgIncludes: Quality Assurance, Utilization Review, Discharge Planning and Worker’s Compensation Claims
With knowledge in federal regulations including Medicare, Worker’s Compensation, CO Dept of Health OSHA, and Joint Commission, the nurses in this department handle a variety of duties. One handles all of the risk issues for the hospital, which includes any pending litigation as well as insurance coverage for the buildings, clinics, the included property and physicians that are employees. This person is also our Compliance Officer.
Utilization Review is basically is reviewing the charts (all inpatient, same day and emergency room visits) for appropriateness of admission and treatment. We work very closely with the individual insurance companies that contact us to check on a patient’s care. We hold ourselves to returning calls from the various companies within 24 hours of receiving them. We work very closely with Patient Accounting and Medical Records. We coordinate the majority of the Discharge Planning along with our Social Services Department.
This department also monitors our in-house Worker’s Compensation program assuring that our employees get the care they need when they have sustained a work related injury.
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1311 N. Mildred Rd. • Cortez, Co, 81321
Main Hospital: 970-565-6666 • Emergency Room: 970-564-2025
