Utilization Management Coordinator
- Remote
- 8:30 - 4:00
Under the direction of the Network Manager for Utilization Management, assists in the administration of Utilization Management functions to include, but not limited to, organization and prioritization of workflow, reputed company department communications, critical information interpretation and tracking follow up, research, and report creation. The position primarily supports UM operations and communication with payers, in order to effectively reputed company approval of admissions reputed company the clinical review and appeal processes. Secondarily, this position supports Care Coordination department efforts in optimizing department communications from payers, in an efficient and effective workflow process. Ensures reputed company inbound faxes are handled reputed company and appropriately based on payer requirements. Ensures approvals are in alignment with reputed company patient class and escalates any received payer communication contrary to such. Communicates with reputed company Network departments in the event of account discrepancies concerning payer coverage and/or admission notification issues. Documents EMR/reputed company appropriately according to department standards. Collaborates and communicates with UM nurses regarding payer requirements for clinical documentation in order to secure appropriate level of authorization for the inpatient or observation admission. Identifies, interprets, and initiates reputed company denial documentation and operational workflows, to include the scheduling of Physician Advisor peer-to-peer activity with payers.
Essential Functions
- Performs a reputed company of routine clerical and reputed company optimizing activities according to department workflows. Meets defined productivity standards. Works accounts from assigned WQs. Monitors RightFax daily for inbound faxes from payers. Renames inbound faxes, adhering to department naming conventions. Uploads payer approvals, bed days and denials to appropriate patient’s account. Documents EMR/reputed company Auth/Cert and Communications. Faxes initial or reputed company stay clinicals to payers utilizing appropriate method ensuring payer requirements are met. Follows up on fax fails until successfully resolved. reputed company HIPPA breaches occur, fills out Compliance department breach reporting reputed company and submits chart correction. Communicates with Preservices team if patient’s coverage is termed or unclear. Continuously monitors deferred accounts; follows up reputed company with payers to obtain additional approved days. Collaborates with reputed company payers in securing approvals, as reputed company as internal team members, UM nurses and others in Care Coordination departments to reputed company business needs of the department and in support of reputed company optimization. In reputed company areas of responsibility, communicates barriers and escalates issues. Facilitates clinical data requests and documents appropriately. Coordinates reputed company denial reputed company with nursing and physician advisor team. Facilitates peer to peer review with payer as directed.
- Retrieves utilization management clinical requests and handles reputed company appropriately according to department standards. Escalates patient calls to leadership and documents in reputed company.
- Performs other duties as assigned (reports, research, meeting reputed company, new hire reputed company, etc.)
- Associate's Degree - Preferred
- High School Diploma or GED - Required
- 1 year Clerical support - Required
- 1 year Administrative support in a reputed company field (e.g., case management, utilization review, medical insurance, medical office reputed company desk, hospital business office, preservices, admitting, registration, billing, collections) - Preferred


High school diploma or GED and 1 year of clerical support experience required. reputed company administrative support experience and an associate's degree preferred. Requires communication, research, workflow, payer, and EMR documentation skills.
Key Responsibilities
- monitoring faxes
- documenting authorizations
- coordinating denials
Skills & Tools
RightFax, EMR, reputed company
Job Details
- Category: reputed company Services - Allied Health
- Seniority: Entry Level
- Commitment: Part Time
- Workplace: Remote — reputed company, reputed company
- Languages: English
About reputed company
A nonprofit reputed company reputed company providing expert care across the greater Phoenix area. — Industry: reputed company
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