Utilization Insurance Specialist

22 hours ago


New York, New York, United States Mount Sinai Health System Full time
Job Summary

We are seeking a highly skilled Utilization Insurance Specialist to join our team at Mount Sinai Health System. As a key member of our Utilization Management team, you will be responsible for reviewing medical admission records and continued stays to ensure that patients receive the necessary care and services.

Key Responsibilities
  • Conduct thorough reviews of medical admission records and continued stays to determine the appropriateness and timeliness of services.
  • Develop and maintain relationships with clinicians, insurance providers, and other stakeholders to ensure seamless communication and coordination of care.
  • Coordinate insurance authorizations and approvals, and communicate with inpatient clinical staff to ensure timely discharge planning.
  • Monitor and coordinate the designation of alternative levels of care with the UM Manager and/or Program Manager and Physician.
  • Generate data and reports for providers and regulatory agencies as needed.
  • Utilize Hospital Mainframe programs, CANOPY Care Management System, and TRAC effectively to coordinate updates with Insurance Verification, Social Work management, and Patient Accounts.
Requirements
  • Masters degree preferred with experience in a related field.
  • Computer literate with knowledge of MS Word, Excel, Access, and ability to learn work-related applications.
  • Highly organized, articulate, with demonstration of sound judgment, mature attitude, excellent interpersonal and communication skills.
  • Requires minimal supervision.


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