Utilization Review Specialist - Full Time, Days (Bellflower)

Position Summary Under the direction of the Director/Manager of Case Management, the Utilization Review Specialist directs all back-office functions of the Case Management Department. Interfaces with all payors/providers requesting authorizations, medical records, and other specific information. Confirms completeness of reviews to payors. Redirects denials to centralized department. Assists the Lead Case Manager with coordinating schedules and assignments of Case Management Team. Provides clerical functions to the Case Management Department, ensuring smooth office operations. Required Qualifications Knowledge of utilization management 2 years works experience Must demonstrate customer service skills appropriate to the job Computer literacy and proficiency Excellent written and verbal communication skills Ability to establish and maintain effective working relationships within the organization Ability to multitask and maintain a work pace appropriate to workload Physical Requirements These are requirements normally expected to perform regular job duties. Reasonable accommodations may be made in compliance with the Americans with Disabilities Act of 1990, and applicable, state and local law, to enable individuals with disabilities to perform the essential functions. Incumbent must be able to successfully perform all of the essential functions of the job with or without reasonable accommodation. Standing - Frequently Walking - Frequently Sitting - Frequently Reaching with Hands and Arms - Occasionally Climb or Balance - Occasionally Stooping, Kneeling, Crouching, or Crawling - Occasionally Talking - Constantly Hearing - Constantly Seeing - Constantly Performing repetitive motions with arms or hands - Occasionally Lifting, carrying, pushing or pulling up to 10 lbs - Occasionally Lifting, carrying, pushing or pulling up to 25 lbs - Occasionally Lifting, carrying, pushing or pulling up to 50 lbs - Occasionally Lifting, carrying, pushing, or pulling greater than 50 lbs - None Driving - Occasionally Essential Job Functions / Major Areas of Responsibility The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position. Interfaces with all payors and providers requesting authorizations, medical records, and other specific information. Completes payor and provider request for missing or additional documentation. Logs all authorization requests to ensure that they are submitted the same day as requested. Forwards all managed care/payor questions, correspondences and authorizations to Director/Manager of Case Management (or designee). Ensures that all requests are handled appropriately and in a timely manner. Performs basic reception functions to ensure smooth office operations, including answering incoming calls, maintaining an accurate filing system, ensuring office supplies stocked to appropriate levels and office equipment serviced, copying forms and documents, etc. Types memos and other case management documents as assigned. Effectively uses computer programs. Accurately collects and documents all necessary and required information and activities into the appropriate computer systems. Clears all providers, such as home health, LTACH, SNF, board and care, prior to providing patient access. Directs providers where they need to go and ensures they get there in a timely manner. Ensures that all patient privacy guidelines/laws are followed. Maintains audits for timely completion of Utilization Reviews. Completes audits for retroactive reviews and provides same day summary to Director of Case Management. Ensures that all reviews are completed and received by the payor in a timely manner. Maintains status and oversees required performance improvement data/documents for current PI/Quality indicators. Cross references multiple sources of data, ensuring that information is in appropriate place in patient medical records. Accurately collects data and organizes graphs, PowerPoints, or needed presentation materials under the direction of the Leader of the Department and/or UR Committee members. Completes all assigned Performance Improvement tasks in a timely and accurate manner. Accurately collects data and organizes graphs, PowerPoints, or needed presentation materials under the direction of the Leader of the Department and/or UR Committee members. Pay Rate: Min - $23.20 l Max - $30.10 Job Listing ID:1897672 #J-18808-Ljbffr NOR Healthcare Systems