Collaborates, coordinates with all members of the health care team, patient, family or significant others to coordinate, ensure timely, efficient delivery of required workflow, services and tasks to support positive patient health care outcomes. Increased patient health care team outcomes, satisfaction. Improved inpatient throughput and appropriate length of stay. Improved communication, awareness, adherence to regulatory requirements associated with utilization. Support for inappropriate level of care and decreased inpatient bed day denials. Continuity and coordination of care. Appropriate, timely authorization for level of care. Decreased denials. Appropriate reimbursement. Supports UM process through accurate, timely communication of review information recorded in MIDAS or Allscripts Care Manager and associated systems to insurance companies including uploading reviews into payer website as required and phone reviews. Remains current with regulatory, internal requirements. Performs daily follow up with payer to obtain authorization. Records all communication with payer according to department standards including date, time of communication, payer contact information as required by department policy. Timely, accurate requests to PAS for registration change to match physician order under the direction of manager or UM Nurse. Notifies UM Nurse of concurrent denial or potential denial as the denial is received so the UM Nurse has the opportunity to provide additional information to support authorization. Must be detail oriented, organized, with good analytical and problem solving ability. Notable client service, communication, presentation, relationship building skills required. Ability to function independently as a team player in a fast paced environment required. Must have strong written, verbal communication skills. Demonstrated ability to use PCs, Microsoft Office suite, general office equipment, strong typing skills required. Medical Terminology preferred.
High School Equivalent / GED Bachelors Degree preferred. Minimum 3 yrs of administrative, office, clinical support, managed care or utilization management experience required.