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- Tasks: Review cases for preauthorization and coordinate admissions with third-party payers.
- Company: Join a healthcare team dedicated to improving patient care and outcomes.
- Benefits: Enjoy flexible spending accounts, retirement plans, and paid time off.
- Why this job: Be part of a supportive team that values innovation and outstanding service.
- Qualifications: High school diploma required; 2 years in Utilization Management preferred.
- Other info: Full-time role with a day shift from 8:00 AM to 4:30 PM.
The predicted salary is between 36000 - 60000 £ per year.
Job Description
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
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Utilization Management Specialist - Rehab Admissions - Days employer: -
Contact Detail:
- Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Utilization Management Specialist - Rehab Admissions - Days
✨Tip Number 1
Familiarise yourself with the pre-certification requirements for Medicare and other third-party payers. Understanding these processes will not only help you in interviews but also demonstrate your commitment to the role.
✨Tip Number 2
Network with professionals already working in Utilization Management. They can provide insights into the day-to-day responsibilities and may even refer you to open positions, increasing your chances of landing the job.
✨Tip Number 3
Stay updated on the latest trends and changes in healthcare regulations related to Utilization Management. This knowledge can set you apart during discussions with hiring managers.
✨Tip Number 4
Prepare specific examples from your past experience that showcase your skills in data collection, analysis, and communication. Being able to articulate these experiences clearly can make a strong impression during interviews.
We think you need these skills to ace Utilization Management Specialist - Rehab Admissions - Days
Some tips for your application 🫡
Understand the Role: Read the job description thoroughly to understand the responsibilities and qualifications required for the Utilization Management Specialist position. Tailor your application to highlight relevant experience and skills.
Highlight Relevant Experience: In your CV and cover letter, emphasise your previous experience in Utilization Management or related fields. Provide specific examples of how you've handled pre-certification requirements and worked with third-party payers.
Showcase Your Skills: Make sure to mention any relevant skills such as data analysis, communication with medical staff, and familiarity with clinical documentation. These are crucial for the role and should be clearly outlined in your application.
Craft a Strong Cover Letter: Write a compelling cover letter that not only summarises your qualifications but also expresses your enthusiasm for the role. Mention why you want to work for the company and how you can contribute to their goals.
How to prepare for a job interview at -
✨Understand the Role
Make sure you thoroughly understand the responsibilities of a Utilization Management Specialist. Familiarise yourself with pre-certification requirements and the importance of timely communication with third-party payers.
✨Prepare for Case Scenarios
Be ready to discuss specific case scenarios during your interview. Think about how you would handle preauthorization requests or concurrent reviews, as this will demonstrate your practical knowledge and problem-solving skills.
✨Showcase Your Communication Skills
Since the role involves liaising between various parties, highlight your communication skills. Prepare examples of how you've effectively communicated complex information in previous roles, especially in high-pressure situations.
✨Research the Company
Take some time to learn about the company’s values and mission. Understanding their approach to Utilization Management will help you align your answers with their expectations and show that you're genuinely interested in the position.
