Utilization Management LeadSanta Barbara Cottage Hospital • Saint Paul, Illinois, United States

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Utilization Management Lead

Santa Barbara Cottage Hospital

Saint Paul, Illinois, United States

Saint Paul, Illinois, United States

Über

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Coordinator - REMOTE. In this role, you will assist and support the clinical team with various administrative and non-clinical tasks that are essential to the processing of Utilization Management prior authorizations and appeals. You will work closely with UM Nurses and the Medical Director to ensure that all requirements are met and documentation is complete. Your impact will be significant as you contribute to the efficiency of healthcare delivery, playing a key part in improving patient outcomes. The role requires strong organizational skills and the ability to adapt to a fast-paced environment, fostering collaboration and teamwork.
Accountabilities
Monitor incoming faxes
Enter UM authorizations review requests using ICD-10 and HCPCS codes
Verify eligibility and claim history in proprietary claims platform
Ensure necessary documentation has been submitted with authorization requests
Contact providers for medical records or documentation related to UM requests
Generate correspondence and assist with member and provider notifications
Complete verbal notifications
Document as required in authorization platform
Initiate appeal cases for UM Nurses to complete
Meet internal and regulatory deadlines for UM cases
Complete inquiries from call center and other sources
Assist with other duties as assigned by UM Director
Requirements
1 year as a UM Coordinator in a managed care payer environment preferred
Knowledge of ICD-10, HCPCS codes, and medical terminology required
Strong time management and organizational skills
Proficiency in Word, Outlook, and other software applications
Ability to collect data and draw valid conclusionsEffective written and oral communication skills
Experience with DMEPOS desired
Medicare/Medicaid experience a plus
Benefits
Competitive compensation and annual bonus program
401(k) retirement program with company match
Company-paid life insurance
Company-paid short term disability coverage
Medical, Vision, and Dental benefits
Paid Time Off (PTO)
Paid Parental Leave
Sick Time
Paid company holidays and floating holidays
Quarterly company-sponsored events
Health and wellness programs
Career development opportunities
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Saint Paul, Illinois, United States

Sprachkenntnisse

English

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