Job Description
Full job description
Description
What You Will Do
Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in:
Support of positive patient health care outcomes
Increased patient/health care team outcomes and satisfaction
Improved inpatient throughput and appropriate length of stay
Improved communication, awareness and adherence to regulatory requirements associated with utilization
Support for appropriate level of care and decreased inpatient bed day denials
Continuity and coordination of care
Appropriate and timely authorization for level of care
Decreased denials
Appropriate reimbursement
Supports UM process through accurate and timely communication of review information recorded in MIDAS or Allscripts Care Manager and associated systems to insurance companies including uploading reviews into payer website as required and phone reviews. Remains current with regulatory and internal requirements.
Performs daily follow-up with payer to obtain authorization.
Records all communication with payer according to department standards including date and time of communication, and payer contact information as required by department policy.
Notifies UM Nurse of concurrent denial or potential denial as the denial is received so the UM Nurse has the opportunity to provide additional information to support authorization.
Additional Responsibilities
Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
Qualifications
Education
High School Equivalent / GED (Required)
Work Experience
2+ years of administrative/office/clinical support/managed care or utilization management experience. (Required)
Knowledge, Skills, & Abilities
Detail-oriented and organized, with good analytical and problem solving ability. (Required proficiency)
Notable client service, communication, presentation and relationship building skills. (Required proficiency)
Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
Must have strong written and verbal communication skills. (Required proficiency)
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency)
Strong typing skills. (Required proficiency)
Medical Terminology. (Preferred proficiency)
Physical Demands
Standing Occasionally
Walking Occasionally
Sitting Constantly
Lifting Rarely 20 lbs
Carrying Rarely 20 lbs
Pushing Rarely 20 lbs
Pulling Rarely 20 lbs
Climbing Rarely 20 lbs
Balancing Rarely
Stooping Rarely
Kneeling Rarely
Crouching Rarely
Crawling Rarely
Reaching Rarely
Handling Occasionally
Grasping Occasionally
Feeling Rarely
Talking Constantly
Hearing Constantly
Repetitive Motions Frequently
Eye/Hand/Foot Coordination Frequently
Travel Requirements
10%
Description
What You Will Do
Collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in:
Support of positive patient health care outcomes
Increased patient/health care team outcomes and satisfaction
Improved inpatient throughput and appropriate length of stay
Improved communication, awareness and adherence to regulatory requirements associated with utilization
Support for appropriate level of care and decreased inpatient bed day denials
Continuity and coordination of care
Appropriate and timely authorization for level of care
Decreased denials
Appropriate reimbursement
Supports UM process through accurate and timely communication of review information recorded in MIDAS or Allscripts Care Manager and associated systems to insurance companies including uploading reviews into payer website as required and phone reviews. Remains current with regulatory and internal requirements.
Performs daily follow-up with payer to obtain authorization.
Records all communication with payer according to department standards including date and time of communication, and payer contact information as required by department policy.
Notifies UM Nurse of concurrent denial or potential denial as the denial is received so the UM Nurse has the opportunity to provide additional information to support authorization.
Additional Responsibilities
Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
Qualifications
Education
High School Equivalent / GED (Required)
Work Experience
2+ years of administrative/office/clinical support/managed care or utilization management experience. (Required)
Knowledge, Skills, & Abilities
Detail-oriented and organized, with good analytical and problem solving ability. (Required proficiency)
Notable client service, communication, presentation and relationship building skills. (Required proficiency)
Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
Must have strong written and verbal communication skills. (Required proficiency)
Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.). (Required proficiency)
Strong typing skills. (Required proficiency)
Medical Terminology. (Preferred proficiency)
Physical Demands
Standing Occasionally
Walking Occasionally
Sitting Constantly
Lifting Rarely 20 lbs
Carrying Rarely 20 lbs
Pushing Rarely 20 lbs
Pulling Rarely 20 lbs
Climbing Rarely 20 lbs
Balancing Rarely
Stooping Rarely
Kneeling Rarely
Crouching Rarely
Crawling Rarely
Reaching Rarely
Handling Occasionally
Grasping Occasionally
Feeling Rarely
Talking Constantly
Hearing Constantly
Repetitive Motions Frequently
Eye/Hand/Foot Coordination Frequently
Travel Requirements
10%
💡 Quick Summary
Seeking a career-building opportunity? The Utilization Management Assistant position is now open for candidates interested in the Work from home Jobs sector. This role in New York offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Work from home Jobs is a plus.
