Utilization Management Coordinator

HOW WE CARE FOR YOU:

At Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.

• Pension Plan
• Retirement Plan
• Comprehensive Benefits Package
• Tuition Reimbursement
• Benefits Effective Date of Hire
• Same Day Pay through Daily Pay

SUMMARY

Coordinate hospital based medical necessity denials for the health system. Responsibilities include managing the workflow with the standard UM sources for potential inpatient medical necessity denials. Act as a liaison for the health system and Executive Health Resources. Responsibilities include concurrent (as needed) and retrospective reviews. Responsibilities include function involved concurrent and retrospective reviews. The Utilization Management Coordinator will act as a resource on denial management as needed across the organization

STATUS: Full time

LOCATION: Riedman Campus

DEPARTMENT: Utilization Management - Physician Advisory Program

SCHEDULE: Monday - Friday days

ATTRIBUTES

• 3 years of Utilization Management experience preferred
• 3 years of acute hospital care, administrative assistance, and/or customer services
• Experience with Abstracting data denials and appeals and maintaining statistics
• Proficient in computer skills (Word, Excel, PowerPoint, etc.)

RESPONSIBILITIES

• Track and monitor all denials, appeals, arbitration responses to payers/audits
• Initiate an E HR 1st, 2nd, and/or arbitration appeals as needed. Document in all areas that an appeal has been initiated or no appeal is necessary per E HR reviews.
• Reconcile E HR inpatient medical necessity denials.
• Receive E HR determination letters and forward to Utilization Review Specialists and/or HIM.
• Review MVP authorization and morning list daily to determine if clinical update is needed, and/or patient was discharged.
• Answering the UM, LOC, and E HR phone lines. Facilitates and responsible for clinical to be e-faxed by the Utilization Review Specialists to support inpatient admission.
• E-fax clinical to the payer per their request to as needed. Retrieve all corresponds from the mail room and sort and track as needed.

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$21.50 - $31.60 Rochester 14621-3038

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer.
Minority/Female/Disability/Veterans by a prospective employee and/or employee’s Physician or delegate will be considered for accommodations.