Utilization Management Assistant

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

As a Utilization Management Assistant you will receive, process, facilitate and document all payer communications.  This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third party payers.  The Utilization Management Assistant supports the Utilization Management Hub department by recognizing trends and opportunities for process improvement and reporting those to leadership.  The Utilization Management Assistant performs these duties with a high degree of accuracy utilizing critical thinking skills and in compliance with hospital policies, standards of practice and Federal and State Regulations.

• 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

Preferred

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