Utilization Management Reviewer - System Care Management - Per Diem

Sayre, PA, United States
Oct 4, 2021

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Job Description

Guthrie Entity

Robert Packer Hospital

Shift

Per Diem/As Needed

Pay Grade

RPH/A10

License

Licensed Practical Nurse

FLSA Status

Non-Exempt

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.

Education

Current LPN licensure or eligibility for licensure required

Experience

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

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Job Info

Oct 4, 2021

122432-1A

United States

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