Utilization Management Assistant

Utilization Management Assistant

The Utilization Management Assistant performs secretarial or clerical functions to support the administrative operations of the Utilization Management department. This position assists by reviewing and scanning prior authorization forms into the electronic medical record system, reviewing and working the high volume of faxes received daily from payers, reviewing surgery schedules, and requesting authorization for services.

With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

What You Can Expect

• Schedule: 3 days a week (Monday - Friday), 9am - 5:30pm EST
• Hybrid schedule - will need to work in office once per week
• Obtain status details regarding care authorizations and supervisory visit requirements from insurance payers.
• Follow payer processes (website, fax, contact number) to submit appropriate clinical documentation; remain current on updates from payers, to ensure appropriate reimbursement from payers.
• Collect clinical information regarding services to be rendered for prior authorizations.
• Contact payers to obtain prior authorizations; enters standardized documentation within electronic medical record, to identify prior authorization and the criteria surrounding each authorization.
• Educate collaborative multi-disciplinary teams regarding the prior authorization process; advise providers and their clinical staff when issues arise relating to obtaining prior authorization.
• Complete administrative duties which include answering telephone calls and directing them to the appropriate team member, if needed, reviewing incoming faxes, manually fax if system is down, provide support to the nurses on the team.
• Process prior authorization forms.
• Respect the sensitive nature of correspondence and consistently maintains confidentiality.
• Assist in the onboarding and training of new coworkers, to ensure all coworkers receive consistent and accurate information.

Qualifications

• High School Diploma/GED required
• 1 year of clerical/office experience preferred
• 1 year of hospital experience preferred

Travel is required: Up to 20%

Equal Opportunity Employer

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site.