Utilization Review Specialist I - FT - Day - Utilization Resource Management Pennington NJ

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.The listed pay range or pay rate reflects compensation for a **full-time equivalent (1.0 FTE)** position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).**Pay Range:**$20.50 - $26.64**Scheduled Weekly Hours:**40**Position Overview**# **Utilization Assistant**JOB CODE:50219FLSA Exemption Status:Non-Exempt## SUMMARY (BASIC PURPOSE OF THE JOB)Works as a member of the multidisciplinary team to provide support for the utilization and denial process. Performs follow-up tasks identified by the Utilization and Denial team to enhance the management of cases and the departments’ processes. Supports the Utilization, Denial and Resource Management Department operations and assists with task to promote positive, timely, cost effective outcomes.## ## MINIMUM REQUIREMENTS**Education**: High school diploma or GED.**Experience**: Two years related office experience.Knowledge and Skills:Knowledge of Word, Excel, and PowerPoint. Must be able to work independently and possess excellent verbal and written communication skills. The Utilization assistant must have the ability to function as a team member and appropriately seek supervision as needed.Special Training:Mental, Behavioral and Emotional Abilities:Demonstrates the ability to organize and prioritize responsibilities and has the ability to interact with all levels of staff in a courteous and professional manner. Must be willing and able to travel between campuses.Usual Work Day:8 Hours## ## REPORTING RELATIONSHIPSIf set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.## ## ESSENTIAL FUNCTIONS* Maintains, on a timely and accurate basis, records and databases of information specific to the department, often of a highly confidential nature. Maintains confidential personnel files for department staff, processes time sheets, and tracks PTO in accordance with policy and procedure, serves as liaison with Payroll and Human Resources.* Collaborates with the Utilization nurses by preparing the Medicare MOON forms for patients and assures the accuracy of the form.* Provides services to utilization and denials management customer base including receptionist activities, troubleshooting, and problem resolution. Provides additional information to customers in accordance with department and CH policies, practices, and procedures.* Coordinates all office activities such as maintaining accurate filing systems, ordering supplies, requesting maintenance and housekeeping services, scheduling appointments, opening and distributing mail, preparing and distributing correspondence, creating daily reports, and setting up meetings.* Assists in issuing the Medicare MOON form to patients and communicates the Medicare Rights to patients and family members if applicable.* Maintains calendars for the Department Head with accuracy, updating as changes occur. Schedules meetings and coordinates meeting arrangements, including facilities, catering, and logistics assuring smooth functioning of events. Makes travel arrangements as needed.* Coordinates the timely and accurate receipt, processing, production, and distribution of regular reports to appropriate department staff.* Enters all denial information received through mail or other correspondence in the appropriate area in the case management system timely and accurately. Maintains accurate records of all denial and appeal activity by following the department workflow for the handling of denials and appeals. Refers all denial and appeal correspondence to appropriate parties for review and response. Follows up for completion and maintains statistics on denial and appeal activity.* Maintain accurate documentation of correspondence and calls in the utilization management software system.* Performs a variety of clerical tasks: monitors and orders office supplies, makes copies, and sends and receives faxes as required.* Monitors and reports on the daily Observation and Outpatient in a bed census.* Organizes and maintains department files and paperwork and ensures that all materials are filed accurately and in a timely manner. Maintains confidentiality of information.* Assists with special programs including data collection for process improvement projects.* Uploads appeal letters and appeal responses and monitors timeliness of appeals.* Assists the nurses with Utilization Management incompletes by using the payer portals to obtain determinations.* Performs other duties as assigned.## ## PHYSICAL DEMANDS AND WORK ENVIRONMENTFrequent physical demands include: Sitting , Standing , Keyboard use/repetitive motion , Talk or Hear Occasional physical demands include: Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities Continuous physical demands include: Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal HearingAnticipated Occupational Exposure Risks Include the following: Bloodborne Pathogens , Chemical , Airborne Communicable Disease**This position is eligible for the following benefits:*** Medical Plan* Prescription drug coverage & In-House Employee Pharmacy* Dental Plan* Vision Plan* Flexible Spending Account (FSA)- Healthcare FSA- Dependent Care FSA* Retirement Savings and Investment Plan* Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance* Supplemental Group Term Life & Accidental Death & Dismemberment Insurance* Disability Benefits – Long Term Disability (LTD)* Disability Benefits – Short Term Disability (STD)* Employee Assistance Program* Commuter Transit* Commuter Parking* Supplemental Life Insurance- Voluntary Life Spouse- Voluntary Life Employee- Voluntary Life Child* Voluntary Legal Services* Voluntary Accident, Critical Illness and Hospital Indemnity Insurance* Voluntary Identity Theft Insurance* Voluntary Pet Insurance* Paid Time-Off ProgramThe pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant #J-18808-Ljbffr Capital Health