utilization management representative 1.0

Department:

11215 Advocate Aurora Health Corporate - Utilization Management

Status:


Full time

Benefits Eligible:

Yes

Hou rs Per Week:

40

Schedule Details/Additional Information:

mon through fri 8-430 every 11th weekend/summer and winter holiday commitment

Pay Range
$20.80 - $31.20

Major Responsibilities:
Manage incoming fax, phone, and portal communications or any other requests from internal and external customers pertaining to clinical requests, approvals, authorizations, and denials; determine action required, and document all activities performed accurately and clearly in the designated database/area(s) of EHR.


Communicate clinical needs, authorizations, and denials to the Utilization Review Nurses and Managers for follow up


Verify insurance information provided by callers, fax, or Portal and send information to payers as requested, including discharge dates and disposition or clinical reviews/summaries prepared by UM RNs (if directed to do), while ensuring that all actions taken align/comply with the confidentiality and HIPAA compliance guidelines


Follow up with payers to validate the authorization and confirm the days approved, and capture approved days in the EHR


Enter data into database, spreadsheets, and perform analysis as directed. Provide efficient, courteous, and expert customer service to all internal and external callers. Open, sort, and process incoming mail/correspondence directed to the Utilization Review. Maintain the department records and files.


Ensure provider compliance with Patient Status Admit Order (PSAO) co-signatures across the hospital sites covered by centralized UM.


Utilize standard reports/patient lists withing the EHR to identify PSAO co-signature delinquencies and follow up with reminders/escalations to physicians to sign admission orders


Follow the standard process to notify treating physician via perfect serve or other approved/designated methods of communication.


Interact with Site and System Physician Advisors based on guidelines for escalation. Document all actions taken and status updates in the EHR.


Maintain PSAO spreadsheet to track signature requests. Provide support and instruction to physicians to assist in the LOC order signature process.


Education/Experience Required:
Level of Education: High School Graduate or equivalent and 4+ years secretarial experience or Associates Degree Years of Experience: 2+ years of secretarial experience - preferably in a medical environment


Knowledge, Skills & Abilities Required:
Competent in advanced functions with Microsoft Outlook, Word, Power Point, Excel and complete basic reporting Type 55+ words per minute Strong critical thinking and communication skills to problem solve, and interact with colleagues, physician and payers. Ability to foster and maintain effective professional relationships, manage conflict while demonstrating Advocate Aurora's Behaviors of Excellence at all times Ability to be flexible and function well in a fast paced, continually changing environment. Assume responsibility for self-development by seeking out opportunities for growth and be an active participant in department, site and system initiatives. Comply with strict adherence to predetermined procedures and processes, safety, compliance and privacy/HIPAA guidelines.
License/Registration/Certification: N/A

Physical Requirements and Working Conditions:


This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.