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Utilization Review Assistant

4 months ago

Chico, United States Enloe Medical Center Full time

Pay range: $20.26/hr - $23.81/hr - $27.35/hr

*Please note, the highest starting rate as a new hire is $22.66/hr, based on applicable experience

POSITION SUMMARY:
The Utilization Review Assistant (URA) functions as a member of the Utilization Management team assigned to coordinate utilization review activities for patients in collaboration with the Utilization Review Nurse and payors. The URA promotes effective utilization review activities using current knowledge, awareness of payor regulations, and assuming a pivotal role with the Utilization Review Nurse to achieve optimal resource outcomes. The URA will maintain the UR phone line. The URA will process UR information for the Utilization Management team and enter data into the current computer system. The URA provides administrative support to the Utilization Management Department and the Utilization Review Nurse(s). The URA creates a cooperative impression throughout all interactions with internal and external customers and works independently to prioritize and manage multiple priorities in a fast-paced environment. They support organizational efforts to assure accurate capture of admission status and helps provide medical records for commercial payors for admission criteria and continued stay as assigned by the Utilization Review Nurse(s). They provide clerical support for UM team, including data entry of insurance information such as authorizations & denials, filing, and preserves the confidential nature of items which they have knowledge The URA contributes to the service excellence mission of Enloe Medical Center and the Case Management Department. The URA is responsible for establishing and maintaining an orderly work environment that supports the smooth operation of the department. They perform other duties as assigned.

EDUCATION / TRAINING / EXPERIENCE:
Minimum:
* Two years' experience working with computers (including databases, spreadsheet and word processing) OR Associate degree or higher in a human service or other health related field OR two years' experience in a medical setting.

Desired:
* Previous experience in a case or utilization management setting
* Previous experience in medical back office, including insurance and billing

SKILLS / KNOWLEDGE / ABILITIES:
Working knowledge of medical terminology. Proficient in the use of Microsoft Word, Excel, and Internet access and use. Skilled in the collection and analysis of data, and assessment of data integrity. Ability to learn state and federal funding sources. Analytical and grammatical skills are necessary to communicate effectively, verbally and in writing. Demonstrates evidence of strong skills in confidentiality, integrity, creativity, and initiative. Demonstrates ability to interact with a wide variety of individuals and handle confidential/sensitive situations and information with tact and sensitivity. Must be able to maintain strict confidentiality always. Must be self-motivated, flexible, detail oriented, and work quickly and accurately in a fast paced environment. Must be able to fulfill the essential functions of the position.