Utilization Review Coordinator - Intermountain Health
Springfield, IL
About the Job
Job Description:
This position provides clerical and administrative support to enhance integrated care management for targeted populations and individuals. Facilitates communication with payers and authorization of services in accordance with regulatory and contractual requirements, patient and family-centered interdisciplinary care planning, effective care coordination, collaboration and communication between healthcare settings, and effective transitions to the appropriate level of care.
This is a 100% remote position however, currently we are unable to consider candidates for remote opportunities in the following states: California, Hawaii, Illinois, New York, Rhode Island, Vermont, Connecticut and Washington. This is a Float position that will cover four Front Range hospitals in our Colorado area.
Schedule - Monday - Friday 8 am - 4:30 pm MST
+ Provides administrative departmental support, including but not limited to phone/phone message management, mail collection and distribution, office supply and equipment maintenance, organizing meetings, and recording meeting minutes.
+ Maintains department resource files, which includes electronic materials and may include web page management.
+ Serves as a liaison between the department and outside organizations or persons including Payers, Physicians and Care Team members, Post-acute Agencies, Patients/Patient Representatives, and other customers of the department.
+ Follows regulatory requirements as defined by CMS, Joint Commission, and State Health Department standards.
+ Delivers CMS required paperwork to patients, obtains signatures if required, and documents delivery in the medical record.
+ Communicates and collaborates with Care Managers, Utilization Review RNs, and Payers as needed to ensure coordinated processes.
+ Under the direction of Care Managers or Utilization Review RNs, makes timely referrals to post-acute care providers, agencies, and community resources and/or communicates with payers appropriately in regard to clinical information to approve or deny current hospitalization of their member(s)
+ Monitors status of referrals, conducts on-going communication as needed, transmits requested clinical information to post-acute providers or payers in a timely manner to obtain authorizations and next review dates for utilization review. Transmits initial request information for Acute Rehab authorizations (SMG)
+ Communicates with post-acute agencies to retrieve pertinent patient information and to verify patient's advance directive, level of care, financial and other information critical to the timely discharge of the patient (Care Management).
+ Communicates referral information, acceptance status, and barriers to successful implementation of the discharge plan to Care Managers and/or payer authorization, next review dates, and denial information to the Utilization RNs in a timely manner- Documents authorizations, denials, requests from post-acute agencies or payers, and all actions performed in the appropriate electronic records.
Minimum Qualifications
+ High School Diploma or equivalent
Preferred Qualifications
+ Associate Degree or higher
+ CNA License, MA Certificate, or other relevant license or certification
+ Two (2) years of healthcare experience. Hospital or clinic experience
+ Experience with EPIC
Physical Requirements:
+ Interact with others by effectively communicating, both orally and in writing.
+ Operate computers and other office equipment requiring the ability to move fingers and hands.
+ See and read computer monitors and documents.
+ Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
+ May require lifting and transporting objects and office supplies, bending, kneeling and reaching.
Location:
Good Samaritan Hospital, Intermountain Health Lutheran Hospital, Platte Valley Hospital, Saint Joseph Hospital
Work City:
Denver
Work State:
Colorado
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$16.83 - $21.88
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
This position provides clerical and administrative support to enhance integrated care management for targeted populations and individuals. Facilitates communication with payers and authorization of services in accordance with regulatory and contractual requirements, patient and family-centered interdisciplinary care planning, effective care coordination, collaboration and communication between healthcare settings, and effective transitions to the appropriate level of care.
This is a 100% remote position however, currently we are unable to consider candidates for remote opportunities in the following states: California, Hawaii, Illinois, New York, Rhode Island, Vermont, Connecticut and Washington. This is a Float position that will cover four Front Range hospitals in our Colorado area.
Schedule - Monday - Friday 8 am - 4:30 pm MST
+ Provides administrative departmental support, including but not limited to phone/phone message management, mail collection and distribution, office supply and equipment maintenance, organizing meetings, and recording meeting minutes.
+ Maintains department resource files, which includes electronic materials and may include web page management.
+ Serves as a liaison between the department and outside organizations or persons including Payers, Physicians and Care Team members, Post-acute Agencies, Patients/Patient Representatives, and other customers of the department.
+ Follows regulatory requirements as defined by CMS, Joint Commission, and State Health Department standards.
+ Delivers CMS required paperwork to patients, obtains signatures if required, and documents delivery in the medical record.
+ Communicates and collaborates with Care Managers, Utilization Review RNs, and Payers as needed to ensure coordinated processes.
+ Under the direction of Care Managers or Utilization Review RNs, makes timely referrals to post-acute care providers, agencies, and community resources and/or communicates with payers appropriately in regard to clinical information to approve or deny current hospitalization of their member(s)
+ Monitors status of referrals, conducts on-going communication as needed, transmits requested clinical information to post-acute providers or payers in a timely manner to obtain authorizations and next review dates for utilization review. Transmits initial request information for Acute Rehab authorizations (SMG)
+ Communicates with post-acute agencies to retrieve pertinent patient information and to verify patient's advance directive, level of care, financial and other information critical to the timely discharge of the patient (Care Management).
+ Communicates referral information, acceptance status, and barriers to successful implementation of the discharge plan to Care Managers and/or payer authorization, next review dates, and denial information to the Utilization RNs in a timely manner- Documents authorizations, denials, requests from post-acute agencies or payers, and all actions performed in the appropriate electronic records.
Minimum Qualifications
+ High School Diploma or equivalent
Preferred Qualifications
+ Associate Degree or higher
+ CNA License, MA Certificate, or other relevant license or certification
+ Two (2) years of healthcare experience. Hospital or clinic experience
+ Experience with EPIC
Physical Requirements:
+ Interact with others by effectively communicating, both orally and in writing.
+ Operate computers and other office equipment requiring the ability to move fingers and hands.
+ See and read computer monitors and documents.
+ Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
+ May require lifting and transporting objects and office supplies, bending, kneeling and reaching.
Location:
Good Samaritan Hospital, Intermountain Health Lutheran Hospital, Platte Valley Hospital, Saint Joseph Hospital
Work City:
Denver
Work State:
Colorado
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$16.83 - $21.88
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
Source : Intermountain Health