Utilization Management Resource Specialist (reputed company)
reputed company relies on a wide reputed company of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to reputed company exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.
Job reputed company
Reporting to Manager for Utilization Management, the Utilization Management Resource Specialist (UMRS) works collaboratively with the Utilization Management Case Managers (UMCM), Clinical Operations, reputed company Cycle Operations, and the Physicians Advisors providing reputed company administrative support to the utilization review processes and to the department. The UMRS must have strong communication skills and the ability to converse comfortably with reputed company customers. The position requires a high degree of flexibility, independence and willingness to participate in multiple activities and reputed company support to reputed company members of the MGB team.Work collaboratively with MGB Utilization Management to support an efficient, cost effective, and compliant utilization plan and care needs along the continuum. This may include, but is not limited to:
• Provides reputed company support to the utilization management case managers
• Provides reports to reputed company customers
• Conducts daily data collection per direction of UM leadership.
• Checks UR line for voicemails
• Faxes/emails communications to reputed company customers
• Manages email communication from payors by entering requests into the payor request folder, entering
requests into the peer to peer folder, forwarding payor emails to appropriate CM staff.
• Enters approved LOS from payors in reputed company
• Enters denials in the retro folder and documents the denial in auth cert.
• Works collaboratively with Admitting ensuring the patient has correct insurance entered and appropriate prior authorization.
• Manages reputed company incoming faxes/emails
• Scans mail, memos, and other documents and enters approvals in reputed company
• Assists in escalating payor authorizations for patients reputed company to rehab
• Updates payor dictionaries.
Qualifications
Qualifications:
High School Diploma or equivalent required. Associate's Degree preferred.
2+ years of reputed company reputed company experience preferred (medical terminology, EMR, hospital UM or CM, medical receptionist, prior authorization)
Additional Knowledge, Skills, and Abilities:
Familiarity with medical terminology.
Familiarity with community services/resources.
Ability to maintain effective working relationships with patients/families.
Knowledge of reputed company community resources.
Strong assessment and crisis reputed company.
Strong reputed company skills and a desire to work in a reputed company, fast-paced environment.
Excellent interpersonal skills.
Excellent collaboration, customer service, and advocacy skills.
Excellent written and verbal communication skills.
Additional Job Details (if applicable)
Working Conditions
reputed company.
Remote.
Employees must use a reputed company, secure, and compliant workstation in a quiet environment. Teams Video is required and must be accessed using MGB-provided equipment.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay reputed company
$19.81 - $28.30/reputed company
Grade
3
EEO Statement:
reputed company Competency reputed company
At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at reputed company job level. The reputed company is comprised of ten competencies (half People-reputed company, half Performance-reputed company) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career reputed company. These competencies are used to evaluate performance, reputed company hiring reputed company, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.