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Utilization Review Specialist

2 months ago

Cleveland, Ohio, United States MetroHealth Full time

Utilization Review Specialist - Utilization Management

Location: METROHEALTH MEDICAL CENTER

Biweekly Hours: 80.00

Shift: 8a to 430p

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary:

Responsible for communicating information to internal and external customers of the Utilization Review and Care Management Department. Follows up on inquiries from payors and provides the appropriate information to Utilization Review, providers, payors, and admitting. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.

Qualifications:

Qualifications:
Required:
Meets one of the following:

• Associate degree from an accredited institution.

• 2 years of experience in medical insurance precertification for either a hospital or insurance company will be accepted in lieu of a degree.
Experience in a clinical or healthcare setting.
Experience with and/or a strong understanding of managed care information systems.
Knowledge of third-party payer information systems and portals.
Knowledge of software programs, including the Microsoft Office Suite (i.e., Word, Excel, etc.).
Strong PC skills.
Strong written, verbal, and interpersonal communication skills.
Ability to multi-task, prioritize work, and meet deadlines.
Ability to work cooperatively in a team environment.

Preferred:
Experience with Epic systems
Demonstrated knowledge of the Utilization Review process.

Physical Requirements:
May sit, stand, stoop, bend, and ambulate intermittently during the day.
May need to sit or stand for extended periods.
See in the normal visual range with or without correction.
Hear in the normal audio range with or without correction.
Finger dexterity to operate office equipment required.
May need to lift to twenty-five (25) pounds on occasion.
Ability to communicate in face-to-face, phone, email, and other communications.
Ability to see computer monitor and departmental documents.