Utilization Review Assistant

Position Purpose

This position will be the main supporting role for the Utilization Review RNs and Utilization Management Coordinators at Renown Health. Under the direction of department leadership, this position participates in the communication and collaboration with insurance payors, Internal Physician Advisors, Community Providers, and Renown staff for coordination of authorization of patient stay.

Nature and Scope

• Supportive role for Utilization Review RN and Utilization Management Coordinator.

• Participates in communication and collaboration with insurance payors, Internal Physician Advisors, community Providers, and Renown staff for coordination of authorization of patient stay.

• Requires critical thinking, collaboration, and communication.

• Works alongside Utilization Review RN and Utilization Management Coordinators to ensure the following:

o Ensure authorization notices are placed in electronic medical records.

o Verify provider orders and patient status are updated appropriately and accurately prior to admission for elective surgeries.

o Coordinate peer-to-peer discussions between providers for denials management.

o Support the Utilization Review RN with timely submission of clinical documentation via fax to insurance payors.

• Manages multiple fax lines while monitoring various reports and insurance portals for authorization notifications.

• Collaborate with community providers to ensure appropriate orders are reflected on surgical accounts prior to the day or surgery.

KNOWLEDGE, SKILLS, & ABILITIES

• Must respect beliefs and values while advocating for the patient’s right to self-determination and to make informed choices.

• Documents all chart and phone reviews, identifies, and communicates potentially avoidable/non-reimbursed days, and quality indicators (such as re-admissions).

• This position acquires and maintains knowledge and competencies related to the expectations of their role. Practice is aligned with the mission, vision, and goals of the Integrated Health System.

• Must be able to prioritize and assess situations while maintaining quality services under stressful conditions.

This position provides clerical and support services.

This position does not provide patient care.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications Requirements - Required and/or Preferred

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing, and speaking English. Understanding of medical terminology preferred.

Experience:

One-year clerical experience in the medical field preferred.

License(s):

None

Certification(s):

None

Computer / Typing:

Must possess the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Computer skills are necessary to access epic and other supporting computer applications.