Utilization Management Coordinator

4 days ago

Hillsboro, United States Sanford Health Full time
Job DescriptionJob Description

Careers With Purpose

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote ND (Central Time)

Location: City - Remote ND, ND

Address:

Shift: Day

Job Schedule: Full time

Weekly Hours: 40.00

Salary Range: 19.00 - 28.00

Department Details

Opportunity to work remote.

Job Summary

Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines. Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported. Provide information via multiple sources of technology applications to insurance companies and contracted vendors to assure authorization for patients. May participate in providing assistance in financial aid and/or counseling if applicable.

Accurately recognizes coding principle diagnosis and principle procedures including complicating/comorbid diagnoses for accurate diagnosis-related group (DRG) assignment during hospitalization. Monitors patient hospitalization to ensure prospective payment limit is not exceeded without due notice to the attending physician. May also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance communication, DRG grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission (TJC) required functions and credentialing. Assists medical records coding personnel as needed to correctly identify diagnoses and procedures, and obtains physician documentation as needed. Monitors patient hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required.

Ability to interact on an interpersonal basis with both providers and nursing staff. Demonstrates proficiency with computers, Microsoft applications, and additional designated technology within the department. Will perform multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs of pediatric to geriatric populations.

Qualifications

Appropriate education level required in accordance with licensure.

Seven years of relevant experience, superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required.

Specific background or experience in healthcare reimbursement, insurance industry, and/or authorization experience would be critical to the success in this role and preferred.

Currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges, or Registered Health Information Technician (RHIT) required. Additionally, pharmacy technician or coding certifications also acceptable, i.e. Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Outpatient Coder (COC), or Certified Ambulance Coder (CAC).

Obtains and subsequently maintains required department specific competencies and certifications.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits .

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0208611

Job Function: Care Coordination

Featured: No

  • Utilization Management Coordinator

    3 days ago

    Hillsboro, United States Sanford Health Full time

    Job DescriptionJob DescriptionCareers With PurposeSanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad...

  • Airframe Manager for Utility Helicopters

    3 weeks ago

    Hillsboro, United States Hillsboro Aviation Full time

    Leadership Opportunity in Aviation MaintenanceWe are seeking a seasoned Airframe Manager to oversee maintenance quality, efficiency, and compliance for our fleet of utility helicopters. As the Director of Maintenance, you will lead a team of experienced mechanics and work closely with senior management to ensure our aircraft meet the highest safety...

  • Clinical Coordination Manager

    2 days ago

    Hillsboro, Oregon, United States Kaiser Permanente Full time

    Kaiser Permanente is a leading healthcare provider seeking a skilled RN Inpatient Care Coordinator to join our team in Hillsboro, Oregon. As a key member of our healthcare team, you will be responsible for coordinating patient transitions, developing and implementing plans of care, and providing education to patients and families.Job DescriptionThe RN...

  • Consulting Utility Forester

    1 month ago

    Hillsboro, United States Eocene Environmental Group Full time

    Sign-On Bonus: $800.Relocation Assistance for Qualified CandidatesAs our next Consulting Utility Forester, you’re on your way to the open road and traveling the trails! We keep the lights on anywhere there’s a power line - whether in the city, the rural countryside, or deep in the remote forest. As a Consulting Utility Forester, you’ll keep communities...

  • Hospitality Breakfast Coordinator

    2 days ago

    Hillsboro, United States Hersha Hospitality Management Full time

    Hersha Hospitality Management is seeking a motivated and organized BREAKFAST SERVICE COORDINATOR to join our team. In this role, you will be responsible for preparing the breakfast bar and ensuring that our guests receive exceptional service.Salary InformationThe salary range for this position is $45,000 - $60,000 per year, with an estimated salary of...

  • Inventory Management Coordinator

    2 weeks ago

    Hillsboro, United States O'Reilly Auto Parts Full time

    About O'Reilly Automotive">We are seeking a highly motivated and detail-oriented Inventory Management Coordinator to join our team. As an Inventory Management Coordinator at O'Reilly Automotive, you will play a critical role in ensuring the sales floor area is well-stocked, organized, and clean.">Key Responsibilities:">">Stock merchandise according...

  • RN Inpatient Care Coordinator

    4 weeks ago

    Hillsboro, United States Kaiser Permanente Full time

    Job Summary: Inpatient Care Managers are Registered Nurses who independently assure patients are admitted to the correct level of care for accurate billing and reimbursement, provide quality, cost effective clinical coordination/care management in acute care and emergency care settings, manage patients with routine and complex transition planning needs by...

  • RN Care Coordinator

    5 months ago

    Hillsboro, United States Kaiser Permanente Full time

    Job Summary: Inpatient Care Managers are Registered Nurses who independently assure patients are admitted to the correct level of care for accurate billing and reimbursement, provide quality, cost effective clinical coordination/care management in acute care and emergency care settings, manage patients with routine and complex transition planning needs by...

  • Nursing Care Coordinator

    3 weeks ago

    Hillsboro, United States Providence Full time

    Career OverviewAs a Registered Nurse Clinical Case Manager (RNCCM) at Providence Medical Group, you will play a vital role in delivering high-quality care to patients with complex medical and psychosocial issues. Our patient-centered medical home (PCMH) teams, led by physicians/providers, rely on your expertise to provide comprehensive care management and...

  • Front Desk Coordinator

    4 weeks ago

    Hillsboro, United States Robert Half Full time

    Job DescriptionJob DescriptionWe are offering a long-term contract-to-hire employment opportunity for a Front Desk Coordinator in Hillsboro, Oregon. As a Front Desk Coordinator, you will be the first point of contact for our client's company, providing administrative support across the organization. Your role will involve handling a multi-line phone...

  • Medical Care Coordinator

    3 weeks ago

    Hillsboro, Oregon, United States Virginia Garcia Memorial Health Center Full time

    Virginia Garcia Memorial Health Center is a leading provider of healthcare services to low-income residents in Washington and Yamhill Counties. We are seeking a highly skilled Medical Care Coordinator to join our team.Job SummaryThe Medical Care Coordinator will be responsible for assessing patients' needs and connecting them to resources in the medical and...

  • Client Service Coordinator

    7 months ago

    Hillsboro, United States Banfield Full time

    The Client Service Coordinator ("CSC") drives the flow of clients and pets through the hospital, maximizes the productivity of the veterinary medical team (in terms of numbers of clients and pets), ensures good communication with associates and clients, and coordinates the care of clients and pets in a happy, welcoming, friendly and efficient manner,...

  • RN Inpatient Care Coordinator

    1 day ago

    Hillsboro, United States Kaiser Permanente Full time

    Job Summary:Inpatient Care Managers are Registered Nurses who independently assure patients are admitted to the correct level of care for accurate billing and reimbursement, provide quality, cost effective clinical coordination/care management in acute care and emergency care settings, manage patients with routine and complex transition planning needs by...

  • Marketing Project Manager

    3 days ago

    Hillsboro, United States Express Employment Full time

    We are seeking a highly skilled Marketing Project Manager to oversee complex print orders from concept to completion.Job OverviewAs a key liaison between clients and production, you will build strong client relationships, provide exceptional customer service, and ensure every detail is handled with precision.ResponsibilitiesWork directly with clients to...

  • Clinical Care Coordinator Specialist

    3 weeks ago

    Hillsboro, United States Kaiser Permanente Full time

    About the RoleKaiser Permanente is seeking a skilled Clinical Care Coordinator Specialist to join our team. In this role, you will play a critical part in ensuring patients receive the highest level of care.Job SummaryThis position involves coordinating post-discharge patient care needs to ensure timely and effective discharge of routine and complex patients...

  • Care Manager RN

    4 weeks ago

    Hillsboro, United States Providence Full time

    Description The Registered Nurse Clinical Case Manager (RNCCM) provides care management and care coordination services for at-risk patients, including patients with complex medical and psychosocial issues. Population-based, chronic care management approaches and application of clinical protocols are integral to the program. This position is a core...

  • Care Manager RN

    4 weeks ago

    Hillsboro, United States Providence Full time

    Description The Registered Nurse Clinical Case Manager (RNCCM) provides care management and care coordination services for at-risk patients, including patients with complex medical and psychosocial issues. Population-based, chronic care management approaches and application of clinical protocols are integral to the program. This position is a core...

  • Engineer III

    6 days ago

    Hillsboro, United States Waste Management Full time

    As an EEO/Affirmative Action Employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, or veteran status. RELOCATION ASSISTANCE AVAILABLE I. Job Summary This position requires an engineer with significant experience in...

  • RN Inpatient Care Coordinator

    4 weeks ago

    Hillsboro, United States Kaiser Permanente Full time

    Job Summary:Inpatient Care Managers are Registered Nurses who independently assure patients are admitted to the correct level of care for accurate billing and reimbursement, provide quality, cost effective clinical coordination/care management in acute care and emergency care settings, manage patients with routine and complex transition planning needs by...

  • Travel Nurse RN: Case Management Specialist

    2 weeks ago

    Hillsboro, United States Cross Country Nurses Full time

    About the JobWe are seeking an experienced travel nurse RN Case Management professional to join our team in Hillsboro, Oregon.Job Description:A travel nurse RN Case Management specialist will work collaboratively with the healthcare team to assess, plan, and coordinate care for individual patients. This role involves ensuring effective utilization of...