Utilization Management Coordinator

Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA This position is responsible for assisting with the coordination of utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers and members. This position is not responsible for providing care to patients. Responsibilities Essential Functions Receives requests for prior authorization, concurrent review, post service, or a claim review, and enters the request in the Utilization Management Platform. Checks eligibility, network status, procedure coverage, prior authorization status, and obtains clinical records in order to prepare authorization for RN or MD review. Communicates the authorization determination to the requestor and/or member. Answers and/or responds to calls from operational phone queues. Assists providers and members by confirming benefits, verifying member eligibility, quoting prior authorization status and answering questions about prior authorizations. Ensures timely notification of decisions to members and providers by fax, mail and telephone. Facilitates Utilization Management processes with Medical Review Officers, UM Nurses, hospitals, physicians and other various internal and external customers. Maintain understanding of business rules and regulatory requirements pertaining to UM processes and operations. Other duties as assigned for preservice, concurrent review, post service and claim reviews. Knowledge / Skills / Abilities Demonstrated potential ability to perform the essential functions as outlined above. Demonstrated human relations and effective communication skills. Demonstrated computer literacy. Ability to handle highly sensitive and confidential issues in a professional manner. Ability to prioritize and organize tasks. Qualifications Required Two years of health care experience or education equivalency. Understanding of medical terminology. Previous experience in a utilization review setting. Preferred Bachelor's degree in a health-related discipline, business, or the equivalency. Coding (CPT, ICD-10, HCPCS and hospital billing codes). Working Conditions and Physical Demands This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions. Physical Requirements Color Determination, Far Vision, Listening, Manual Dexterity, Near Vision, Sitting, Speaking, Standing Multi-lingual Candidates Welcomed EEO Statement University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations. All qualified individuals are encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Aff i formative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both. To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at View phone number on click.appcast.io. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at: This position may require the successful completion of a criminal background check and/or drug screen. #J-18808-Ljbffr