Utilization Management Coordinator - Center for Care Management - FT Days
Company: Sanford Health
Location: Sioux Falls
Posted on: June 10, 2021
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Job Description:
Sanford Health is one of the largest and fastest-growing
not-for-profit health systems in the United States. We're proud to
offer many development and advancement opportunities to our nearly
50,000 members of the Sanford Family who are dedicated to the work
of health and healing across our broad footprint. Create Your Career With Us! Facility: Central Patient Building Location: Sioux Falls, SD Address: 1305 W 18th St, Sioux Falls, SD 57105, USA Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Department Details 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. 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. Benefits Sanford Health offers an attractive benefits package for
qualifying full-time and part-time employees. Depending on
eligibility, a variety of benefits include health insurance, dental
insurance, vision insurance, life insurance, a 401(k) retirement
plan, work/life balance benefits, sick leave and paid time off. To
review your benefit eligibility, visit https://sanfordhealth.jobs/benefits
. 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
1-877-673-0854 or send an email to talent@sanfordhealth.org . Sanford Health has a Drug Free Workplace Policy. An accepted
offer will require a drug screen and pre-employment background
screening as a condition of employment. Job Function: Care Coordination Req Number: R-48171 Featured: No
Keywords: Sanford Health, Sioux Falls , Utilization Management Coordinator - Center for Care Management - FT Days, Other , Sioux Falls, South Dakota
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