Per Diem On-Site Utilization & Authorizations Specialist

St. Joseph's Health; City of Syracuse (NY); On-site; USD 32,000 - 47,000; Part time

Job summary

St. Joseph’s Health is seeking a part-time, on-site Insurance Specialist to support Utilization Management. The role is per diem with day shift, up to 3 days per week, working on site at Trinity Health facilities.

Responsibilities include coordinating authorizations, data extraction from patient records, and communicating with care teams to ensure compliant, cost-effective care. Strong medical terminology and prior utilization review/billing experience are preferred.

Qualifications

• High School Diploma or Associate degree preferred.
• One year healthcare experience with medical terminology or related coursework.
• One year of case management, utilization review, billing or coding experience preferred.

Responsibilities

• Initiates and ensures authorizations for all admissions.
• Extracts meaningful data from the medical record of identified patients.
• Processes electronic communications within identified process standards.
• Participates in quality activities with the care management team to improve outcomes.
• Forwards information to Utilization Management/Concurrent Review Nurse when denials are identified.
• Reviews service denials and gathers supporting documentation from charts.
• Provides external notifications of discharges and post-acute transfers.
• Clarifies health plan medical benefits, policies and procedures for stakeholders.
• Participates in clinical utilization review discussions with facilities.

Education

High School Diploma / Associates degree in a healthcare related field

Job description

St. Joseph’s Health is seeking a part-time, on-site Insurance Specialist to support Utilization Management. The role is per diem with day shift, up to 3 days per week, working on site at Trinity Health facilities.

Responsibilities include coordinating authorizations, data extraction from patient records, and communicating with care teams to ensure compliant, cost-effective care. Strong medical terminology and prior utilization review/billing experience are preferred.