Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for assisting with the coordination of case management clients, utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers and members. This position is not responsible for providing care to patients.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
- Receives medial reviews and pended claim requests and data enters it into IDX.
- Prepares paperwork for RN or MD review.
- Communicates the results of the review to the requestor.
- Answers the utilization management phone and fields calls for the case managers.
- Assists providers and members by quoting benefits, verifying eligibility and answering questions about appeals.
- Creates a case in IDX for all hospital admissions.
- Assists the concurrent review nurse in requesting clinical reviews from the hospital case managers.
- Verifies eligibility and creates cases in IDX for all high risk or potential high risk members.
- Mails letters and education information to members.
- Creates, maintains, updates and files all case management charts.
- Maintains master case management list.
Knowledge / Skills / Abilities
- Demonstrated potential ability to perform the essential functions as outlined above.
- Demonstrated human relations and effective communication skills.
- Demonstrated computer literacy.
- Ability to handle highly sensitive and confidential issues in a professional manner.
- Ability to prioritize and organize tasks.
Qualifications
Qualifications Required
- Two years of ICD-9, CPT coding or managed health care experience or education equivalency.
- Previous experience in a utilization review setting.
- Completion of a hospital provided Medical Terminology course within six months of hire.
Qualifications (Preferred)
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
- This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.
Physical Requirements
Carrying, Color Determination, Far Vision, Lifting, Listening, Manual Dexterity, Near Vision, Pulling and/or Pushing, Reaching, Sitting, Speaking, Standing, Walking
EEO Statement
University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students from diverse backgrounds and possess a strong commitment to improving access to higher education for historically underrepresented students.
Individuals from historically underrepresented groups, such as minorities, women, qualified persons with disabilities and protected veterans are encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.
University of Utah Heath Hospitals and Clinics, a part of The University of Utah, is an Affirmative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran’s status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both.
To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500.If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity and Affirmative Action:
Sherrie Hayashi
Director/ Title IX Coordinator
Office of Equal Opportunity and Affirmative Action (OEO/AA)
135 Park Building
Salt Lake City, UT 84112
801-581-8365
Online reports may be submitted atoeo.utah.edu/
For more information: https://www.utah.edu/nondiscrimination/
To inquire about this posting, email: [email protected]
The University is a participating employer with Utah Retirement Systems (“URS”). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics Human Resources at (801) 581-6500 for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at (801) 366-7770 or (800) 695-4877 or Hospitals and Clinics Human Resources at (801) 581-6500 if you have questions regarding the post-retirement rules.
This position may require the successful completion of a criminal background check and/or drug screen.
Requisition Number 51913
Reg/Temp Regular
Employment Type Part-Time
Shift Weekend
Work Schedule Saturday and Sunday (half days)
Location Name University of Utah Health Plans
Patient Care? No
City Murray
State UT
Department UIP CST 01H UUHP CLINICAL OPRN
Category Insurance / Health Plans
Source: Indeed.com
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