Utilization Management Coordinator

🕒 il y a 9 jours

🌵 Arizona – Distant

🌵 Arizona – Remote

⏱ Temps Partiel

🟢 Junior

🚫👨‍🎓 Aucun diplôme requis

👻 Score fantôme 20%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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HonorHealth

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 2013

🏥 Santé

📚 Éducation

Healthcare • Education

HonorHealth est une organisation de santé intégrée qui propose des services médicaux hospitaliers et ambulatoires, des soins primaires, des soins d'urgence, la télésanté (E-Visites) et des outils numériques pour les patients comme MyChart. L'organisation exploite également un institut de recherche, offre des programmes académiques (résidences, bourses, FMC, ressources pour les étudiants en médecine), gère une fondation et des programmes communautaires/volontaires, et fournit des ressources pour les patients telles que la facturation, la transparence des prix et la prise de rendez-vous en ligne. HonorHealth se positionne comme un système de santé axé sur la communauté offrant des soins cliniques, de l'éducation et de la recherche.

Description

• Assist with administration of Utilization Management functions, including workflow organization, prioritization, communications, information interpretation, tracking follow-up, research, and report creation • Support UM operations and communicate with payers to obtain admission approvals through clinical review and appeal processes • Support Care Coordination department efforts to optimize payer communications and workflow • Monitor RightFax daily for inbound payer faxes • Rename inbound faxes according to department naming conventions • Upload payer approvals, bed days, and denials to patient accounts • Document EMR/EPIC authorizations, certifications, and communications • Fax initial or continued-stay clinical documentation to payers and resolve fax failures • Complete Compliance department breach reporting and submit chart corrections when HIPAA breaches occur • Communicate with Preservices regarding terminated or unclear patient coverage • Monitor deferred accounts and follow up with payers to obtain additional approved days • Collaborate with external payers, UM nurses, and Care Coordination team members to secure approvals and optimize revenue • Facilitate clinical data requests and concurrent denial resolution • Schedule physician advisor peer-to-peer activity and facilitate peer-to-peer reviews with payers • Retrieve and appropriately handle utilization management clinical requests • Escalate patient calls to leadership and document them in EPIC/EMR • Perform other assigned duties, including reports, research, meeting scribe duties, and new-hire onboarding

🎯 Exigences

• High School Diploma or GED - Required • Associate's Degree - Preferred • 1 year clerical support experience - Required • 1 year administrative support experience in a healthcare field (e.g., case management, utilization review, medical insurance, medical office front desk, hospital business office, preservices, admitting, registration, billing, collections) - Preferred • Ability to perform routine clerical and revenue optimizing activities according to department workflows • Ability to meet defined productivity standards • Ability to monitor, rename, upload, document, and process payer faxes and approvals • Ability to document appropriately in EMR/EPIC • Ability to communicate and collaborate with UM nurses, payers, physician advisors, and Care Coordination teams • Ability to facilitate peer-to-peer reviews and concurrent denial resolution • Ability to follow payer requirements and department standards • Ability to escalate barriers, issues, and patient calls appropriately

🏖️ Avantages

• Benefits information is available through the employer's Benefits link; no specific benefits are stated in the posting.