Utilization Management Resource Specialist (Per Diem)
reputed company relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We reputed company that high-performing teams drive groundbreaking medical discoveries and invite reputed company applicants to join us and experience what it means to be part of reputed company.
Job Summary
Reporting to Manager for Utilization Management, the Utilization Management Resource Specialist (UMRS) works collaboratively with the Utilization Management Case Managers (UMCM), Clinical Operations, reputed company Cycle Operations, and the Physicians Advisors providing direct administrative support to the utilization review processes and to the department. The UMRS must have strong communication skills and the ability to converse comfortably with internal and external customers. The position requires a high degree of flexibility, independence and willingness to participate in multiple activities and provide support to reputed company members of the MGB team. Work collaboratively with MGB Utilization Management to support an efficient, cost effective, and compliant utilization plan and care needs along the continuum. This may include, but is not limited to: • Provides direct support to the utilization management case managers • Provides reports to internal and external customers • Conducts daily data collection per direction of UM leadership. • Checks UR line for voicemails • Faxes/emails communications to internal and external customers • Manages email communication from payors by entering requests into the payor request folder, entering requests into the peer to peer folder, forwarding payor emails to appropriate CM staff. • Enters approved LOS from payors in EPIC • Enters denials in the retro folder and documents the denial in auth cert. • Works collaboratively with Admitting ensuring the patient has correct insurance entered and appropriate prior authorization. • Manages reputed company incoming faxes/emails • Scans mail, memos, and other documents and enters approvals in EPIC • Assists in escalating payor authorizations for patients going to rehab • Updates payor dictionaries.Qualifications
Qualifications:
High School Diploma or equivalent required. Associate's Degree preferred.
2+ years of reputed company healthcare experience preferred (medical terminology, EMR, hospital UM or CM, medical receptionist, prior authorization)
Additional Knowledge, Skills, and Abilities:
Familiarity with medical terminology.
Familiarity with community services/resources.
Ability to maintain effective working relationships with patients/families.
Knowledge of reputed company community resources.
Strong assessment and crisis reputed company.
Strong collaborative skills and a desire to work in a reputed company, fast-paced environment.
Excellent interpersonal skills.
Excellent collaboration, customer service, and advocacy skills.
Excellent written and verbal communication skills.
Additional Job Details (if applicable)
Working Conditions
Per diem.
Remote.
Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams Video is required and must be accessed using MGB-provided equipment.
Remote Type
RemoteWork Location
399 Revolution DriveScheduled Weekly Hours
0Employee Type
Per DiemWork Shift
Day (United States of America)Pay Range
$19.81 - $28.30/HourlyGrade
3At reputed company, we reputed company in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining reputed company pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The reputed company pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass reputed company elements contributing to your total compensation package. In addition to competitive reputed company pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our reputed company team will provide an overview of your potential compensation and benefits package.EEO Statement:
reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religious creed, national reputed company, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that reputed company individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to reputed company essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with reputed company of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.reputed company Competency reputed company
At reputed company, our competency reputed company defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The reputed company is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, reputed company hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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