Utilization Management Assistant

CHI Health Immanuel, located in North Omaha just off of I-680 on 72nd Street, offers a full-service hospital, cancer center, rehabilitation center, specialty spine hospital and more. For well over a century, our commitment to serve our community inspires our staff to provide the highest quality of care to all who we have the privilege to serve.

• Receives, sends and documents payer requests for clinical documentation.
• Receives and documents payer authorization and communications including but not limited to concurrent denials.
• Coordination of peer to peer conversations, as applicable.
• Reviews surgery schedule to verify correct authorization is documented, if applicable.
• Identifies accounts lacking authorization and follows up with payers, as needed.
• Communicates with interdepartmental staff regarding payer documentation requests.
• Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
• Identifies and reports trends to department Leadership.
• Utilizes payer related reports from Care Management software, where applicable.
• Collaborates with and supports the UM team including but not limited to UR and Denials RN.
• Contributes to the identification of opportunities for process improvement.
• Supports administrative departmental functions, as assigned.

Required

• Minimum one year experience in a hospital, physician’s office, or medical group performing duties related to admitting, business office, payer communications or managed care or an equivalent combination of education and experience 
• High school diploma or GED required

Preferred

• An understanding of operations and functions of care coordination, utilization management, denials mitigation is preferred.