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Utilization Management Coordinator

Company: Sanford Health
Location: Sioux Falls
Posted on: December 3, 2019

Job Description:

Employer Sanford Health Location Sioux Falls, South Dakota Salary Join our team! Posted Nov 15, 2019 Ref 14750 Industry Healthcare Role Manager Job Type Long-Term You need to sign in or create an account to save Job Title: Utilization Management Coordinator City: Sioux Falls State: SD Department : Utilization Management - Sioux Falls Job Schedule: Full Time Shift: Days Hours Per Shift: 8 hr JOB SUMMARY Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines. Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported. Provide information via multiple sources of technology applications to insurance companies and contracted vendors to assure authorization for patients. May participate in providing assistance in financial aid and/or counseling if applicable. Accurately recognizes coding principle diagnosis and principle procedures including complicating/comorbid diagnoses for accurate diagnosis-related group (DRG) assignment during hospitalization. Monitors patient hospitalization to ensure prospective payment limit is not exceeded without due notice to the attending physician. May also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance communication, DRG grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission (TJC) required functions and credentialing. Assists medical records coding personnel as needed to correctly identify diagnoses and procedures, and obtains physician documentation as needed. Monitors patient hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required. Ability to interact on an interpersonal basis with both providers and nursing staff. Demonstrates proficiency with computers, Microsoft applications, and additional designated technology within the department. Will perform multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs of pediatric to geriatric populations. POSITION RESPONSIBILITIES Explains the best practices, key processes and benchmarks for a specific insurance product.;Presents a professional image, especially when dealing with customers.;Demonstrates an ability to meet own responsibilities.;Delivers written and oral communication, responds to questions and concerns, and produce specific outcomes and impact.;Operates and maintains standard office equipment such as copiers, faxes, phones.;Maintains sense of commitment to success, personal achievement and satisfaction.;Assesses common problems and associated approaches to resolution.;Maintains a sense of urgency and a positive attitude.;Applies available tools and resources to work efficiently.;Follows-up with customers to answer questions and ensure satisfaction.; DEPARTMENT DETAILS QUALIFICATIONS Appropriate education level required in accordance with licensure. Seven years of relevant experience, superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required. Specific background or experience in healthcare reimbursement, insurance industry, and/or authorization experience would be critical to the success in this role and preferred. Currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges, or Registered Health Information Technician (RHIT) required. Additionally, coding certifications also acceptable, i.e. Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Outpatient Coder (COC), or Certified Ambulance Coder (CAC). Obtains and subsequently maintains required department specific competencies and certifications. About Sanford Health: At Sanford Health, we are dedicated to the work of health and healing. Every day, we show that commitment by delivering the highest quality of care to the communities we serve. We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities. In addition to strong clinical care, we are also committed to research, education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases. We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world. The entire team at Sanford Health recognizes the value of healthy families and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-************ or send an email to ************************ . City: Sioux Falls State: SD Job Function: Care Coordination Job Schedule: Full Time Shift: Days Req Number: WD14750

Keywords: Sanford Health, Sioux Falls , Utilization Management Coordinator, Executive , Sioux Falls, South Dakota

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