Utilization Management Reviewer - System Care Management - Full Time

Sayre, PA, United States
Oct 4, 2021


Job Description

Guthrie Entity

Robert Packer Hospital



40 hours/week

Pay Grade



Licensed Practical Nurse

FLSA Status


Main Function

The Utilization Management (UM) Reviewer, in collaboration with other internal and external offices, payors, and providers and staff, is responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer:
Secures authorization as appropriate
Documents payer authorization
Screens the appropriateness of level of care/service
Facilitates issue resolution with payer sources in collaboration with other hospital departments or clinic offices as appropriate
Demonstrating ongoing competence in payer requirements, as defined collaboratively with Patient Business Services and Care Coordination
Supports data collection and aggregation associated with UM processes and operations.


Current LPN licensure or eligibility for licensure required


Minimum of five years clinical experience in an acute health care setting. Must possess strong communication and organizational skills, be able to work independently and to complete work within specified time frames.  Knowledge of health benefit plans and related UM requirements preferred.  Experience with CPT/ICD coding, medical record or chart auditing, and experience in utilization management processes preferred.  Knowledge of computer applications (such as Microsoft word processing and spreadsheets) desirable

How To Apply

Guthrie is an equal opportunity employer. To apply for a position at Guthrie please visit www.guthrie.org/careers


Job Info

Oct 4, 2021


United States

Frequent Location Searches

Frequent Job Searches

Most Recent Job Searches

Recently Viewed Jobs