• Supportive role for Utilization Review RN and Utilization Management Coordinator.
• Participates in communication and collaboration with insurance payors, Internal Physician Advisors, community Providers, and Renown staff for coordination of authorization of patient stay.
• Requires critical thinking, collaboration, and communication.
• Works alongside Utilization Review RN and Utilization Management Coordinators to ensure the following:
o Ensure authorization notices are placed in electronic medical records.
o Verify provider orders and patient status are updated appropriately and accurately prior to admission for elective surgeries.
o Coordinate peer-to-peer discussions between providers for denials management.
o Support the Utilization Review RN with timely submission of clinical documentation via fax to insurance payors.
• Manages multiple fax lines while monitoring various reports and insurance portals for authorization notifications.
• Collaborate with community providers to ensure appropriate orders are reflected on surgical accounts prior to the day or surgery.
KNOWLEDGE, SKILLS, & ABILITIES
• Must respect beliefs and values while advocating for the patient’s right to self-determination and to make informed choices.
• Documents all chart and phone reviews, identifies, and communicates potentially avoidable/non-reimbursed days, and quality indicators (such as re-admissions).
• This position acquires and maintains knowledge and competencies related to the expectations of their role. Practice is aligned with the mission, vision, and goals of the Integrated Health System.
• Must be able to prioritize and assess situations while maintaining quality services under stressful conditions.
This position provides clerical and support services.
This position does not provide patient care.
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