Address
Form of work
SalaryWorks under the direction of the U.M. Manager to provide assistance with utilization review process including communicating clinical information/reviews to third party and governmental payers to ensure certification/approval of inpatient hospital services for the Medical Assistance patient population.
Manager - 3-5 sentence statement generally describing the position (not bullet points). Please summarize job duties, scope at a high level.
Essential Functions
- Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
(Do not delete, move or over-write this statement)
- Negotiates with payer (DPW) and other commercial payers to obtain authorization for appropriate level of care and length of stay.
- Responsible for meeting insurer timeframes regarding review of clinical information.
- Provides prompt feedback regarding denials and other payer determinations to the U.M. Manager.
- Coordinates appeal requests (telecom and other payers) with payers as directed by U.M. Manager.
- Interacts with co-workers and other staff consistent with the core values of the hospital.
Education:
High School Diploma – required
AND
Experience:
Two years of experience in a health care setting preferred. Computer literate, strong knowledge of medical terminology required.
Covid Vaccination is a requirement for employment at Jefferson for employees working at Jefferson’s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.
Jefferson includes Thomas Jefferson University and Jefferson Health, a dynamic university and health system with broad reach across the Delaware Valley. Jefferson is the second largest employer in Philadelphia and the largest health system in Philadelphia based on total licensed beds.
Through the merger of Thomas Jefferson University and Philadelphia University in 2017, our University includes ten colleges and four schools. We are an NCAA Division II university and an R2 national doctoral university offering undergraduate and graduate-level programs that provide students with a forward-thinking education in architecture, business, design, engineering, fashion and textiles, health, medicine and social science.
Jefferson Health, the clinical arm of Thomas Jefferson University, has grown from a three-hospital academic health center in 2015, to an 18-hospital health system through mergers and combinations that include hospitals at Abington Health, Aria Health, Kennedy Health, Magee Rehabilitation and Einstein Healthcare Network. We have over 50 outpatient and urgent care centers; ten Magnet®-designated hospitals (recognized by the ANCC for nursing excellence); the NCI-designated Sidney Kimmel Cancer Center (one of only 70 in the country and one of only two in the region); and one of the largest faculty-based telehealth networks in the country. In 2021, Jefferson Health became the sole owner of HealthPartners Plan, a not-for-profit health maintenance organization in Southeastern Pennsylvania. We are the first health system regionally to create an aligned payer-provider partnership.
Jefferson’s mission, vision and values create an organization that attracts the best and the brightest students, faculty, staff, and healthcare professionals, as well as the most visionary leaders to drive exceptional results.
- OUR MISSION: We improve lives.
- OUR VISION: Reimagining health, education and discovery to create unparalleled value
- OUR VALUES: Put People First, Be Bold & Think Differently and Do the Right Thing
As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.
