Utilization Management Support Specialist II

🔥 12 hours ago

🏄 California, Nevada, +1 more states – Remote

🏄 California – Remote 🎰 Nevada – Remote 🤠 Texas – Remote

💵 $30 - $45 / hour

⏰ Full Time

🟢 Junior

💝 Customer Support

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Sutter Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded Sutter Health was founded in 1996.

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 Non-profit

💰 Grant on 2016-11

Healthcare • Healthcare Insurance • Non-profit

Sutter Health is a not-for-profit health system serving Northern California, offering a wide range of healthcare services. It provides comprehensive primary and specialty care, including mental health, oncology, orthopedics, women's health, and more. The organization supports both in-person and virtual visits, ensuring accessibility to its services. Sutter Health is also involved in medical research, education, and offers various health plans, including Sutter Health Plus. It emphasizes innovative, compassionate care and maintains a network of hospitals, medical groups, and other health providers across Northern California.

📋 Description

• Accumulate, process, interpret, and document payer information to justify acute hospital admission, continued stay, and appropriate level-of-care billing • Process concurrent and retrospective denials in collaboration with clinical utilization management staff and internal physician advisors • Develop, coordinate, and monitor appeal and denial process systems under management direction • Track and trend data • Coordinate utilization management operations with leadership and key stakeholders • Liaise with leadership, external payers, staff, and related departments • Troubleshoot, track, and trend level-of-service and payer behavior issues • Identify opportunities for improvement • Assist with assigned projects and participate in department meetings and team discussions • Adhere to privacy, safety, and regulatory requirements while supporting optimal patient care

🎯 Requirements

• HS Diploma or General Education Diploma (GED), or equivalent experience accepted in lieu of the required degree or diploma • 1 year of recent relevant experience • Working knowledge of medical terminology • Experience with medical insurance verification and payer reimbursement plans • Knowledge of revenue cycle processes and criteria required for payment processes • Demonstrated knowledge of electronic health records and computer applications • Written and verbal communication skills • Time management and organizational skills • Ability to prioritize assignments and meet deadlines, production, and quality standards • Ability to work independently and as part of a team • Ability to identify, evaluate, and solve problems using established options • Ability to build collaborative relationships with internal and external customers • Ability to work rotating weekends • Ability to comply with local, state, and federal regulations, codes of conduct, policies, and procedures

🏖️ Benefits

• Comprehensive benefits package for eligible positions • Total rewards program • Regular employee status • Full-time schedule with 40 weekly hours