Utilization Specialist – Skagit Regional Health – Mount Vernon, WA

MISSION: To improve the health of our community, serving with compassion and respect, one person at a time.

VISION: Working together, Skagit Regional Health will transform healthcare by improving access, service, quality and efficiency in support of our goal of a healthier community.

Values:
People: We are committed to putting patients and their families first, dedicated to the success and wellbeing of our patients and guests, and will recruit and retain the highest quality care team.

We are dedicated to collaboration with our communities to promote health and wellness.

Quality: We will demonstrate the highest level of care, safety, customer service and compassion at all times.

We are committed to quality, innovation and serving as a leader in health care.

Stewardship: We will responsibly manage our resources for the benefit of our communities and remain true to our mission.

Respect: We are mindful in our efforts to always show respect, dignity and kindness to our diverse communities, caring for their physical emotional and spiritual needs.

Diversity: We advocate inclusion and embrace the differences of the individuals with whom we work and the communities we serve.

Job Summary:

Reviews chart documentation to justify patient care in order to meet agency reimbursement requirements, justify admission, treatment and length of stay. Works effectively and cooperatively within the workplace. Location/Department specific tasks and competencies may apply.

Essential functions:

Coordinate and track utilization management authorizations from third-party payers, including precertification, concurrent and retrospective authorizations for the Case Management team. Coordinate and facilitate medical record information required for authorizations and appeals management for Medicare/Medicaid/Commercial payers. Utilize communication, organizational, and problem solving skills to implement the plans and interventions defined by the RN Case Managers and Social Workers. Promote and evaluates the effective utilization of resources using current knowledge, awareness of community services, and assuming a pivotal role with the patient care team to achieve optimal clinical and resource outcomes around post acute care transitions. Obtain Medical Assistance authorizations and conducts financial chart auditing to further define resources available for post-acute care facilitation. Maintain ability to effectively utilize Microsoft Office (Outlook) and department specific software applications to perform work. Communicate effectively and cooperatively in the workplace. Actively contribute to the achievement of Quality Improvement and Lean Process Improvement activities. Complete all mandatory learning requirements in a timely manner. Maintain current licensure and/or certification as required. Attend and actively participate in all department, team and/or committee meetings. Comply with all Skagit Regional Health, department and location specific policies and procedures. Perform other duties as assigned by Supervisor or designee.

Education:

High School diploma or GED required. Experience/Training: Minimum one (1) year current related utilization management experience preferred. License/Certifications: None required.

Other Skills: Effective verbal, written and interpersonal communication skills required. Must be able to effectively utilize Microsoft Office applications to perform work. Well developed problem solving and analytical skills required. Must be able to effectively prioritize workload amongst frequent interruptions with competing priorities. Knowledge of utilization management and pre-authorization. Ability to coordinate work schedule with requirements of position (may include overtime and weekend work).

Physical Demands & Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.

About Us: Skagit Regional Health the umbrella name for Skagit Valley Hospital, Skagit Regional Clinics, and Cascade Valley Hospital and Clinics is a health care leader in Northwest Washington, providing advanced, quality and comprehensive services to the people of our communities. Skagit Regional Health has been recognized as a “Leader in LGBT Healthcare Equality” by the Human Rights Campaign (HRC). Skagit Regional Health is a smoke free campus and is committed to Safety, Compassion, Presentation, and Efficiency.

Job Type: Full-time

Benefits:

  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance

Schedule:

Education:

  • High school or equivalent (Preferred)

Experience:

  • Utilization review: 1 year (Preferred)

Work Location: One location

Source: Indeed.com
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