Hybrid Utilization Management Specialist - Rehab Admissions - Days bei WellSpan Medical Group
WellSpan Medical Group · York, Vereinigte Staaten Von Amerika · Hybrid
- Junior
- Optionales Büro in York
General Summary
Performs a variety of duties related to pre-certification requirements for Medicare, Medical Assistance and third-party payers. Ensures timely notification and communication of pertinent clinical data to support admission, clinical condition, and continued stay. Assists with data collection, analysis and reporting.
Shift
Full Time, 8:00-4:30p
Responsibilities
Duties and Responsibilities
Essential Functions:
- Reviews assigned cases for preauthorization and coordinates authorization and certification.
- Performs concurrent review of cases to obtain continued stay authorization.
- Provides notification of discharge date and discharge destination to payer.
- Works closely with and prepares information for outside review agencies.
- Assists with the collection and analysis of utilization patterns and denied cases.
- Supports the Utilization Management Nurse with case research and analysis.
- Works with medical and professional staff on a case-by-case basis to obtain appropriate clinical documentation for review as well as coding activities and DRG assignments.
- Liaisons between third party payors, physician advisor team and the care team regarding questions related to authorization status and/or contractual guidelines.
- Refers third party payer denials and downgrades to the physician advisor team and follow through with the recommendations.
- Provides feedback to payer contracting regarding payer actions that cause barriers to the utilization review process.
- Maintains up to date tip sheet on assigned payer/payers utilization review process.
Common Expectations:
- Maintains established policies and procedures, objectives, quality assessment and safety standards.
- Participates in educational programs and inservice meetings.
- Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Qualifications
Qualifications
Minimum Education:
- High School Diploma or GED Required
- Associates Degree Preferred
Work Experience:
- 2 years Utilization Management. Required
Knowledge, Skills, and Abilities:
- Basic computer skills.
Benefits Offered:
- Comprehensive health benefits
- Flexible spending and health savings accounts
- Retirement savings plan
- Paid time off (PTO)
- Short-term disability
- Education assistance
- Financial education and support, including DailyPay
- Wellness and Wellbeing programs
- Caregiver support via Wellthy
- Childcare referral service via Wellthy
