Utilization Management Assoc / Clinical Resource Management

Hartford HealthCare; Wethersfield (CT); On-site; USD 50,000 - 70,000; Full time

Job summary

Hartford HealthCare in Connecticut seeks a Clinical Resource Management Associate to join the Care Management team. The role focuses on providing support and coordination of utilization management services for the Utilization Management department.

Responsibilities include monitoring EPIC queues, updating authorizations/denials, assisting with denials and appeals, triaging calls, and coordinating with payers and departments.

Qualifications

• High School Diploma required; Medical Administrative Assistant certification preferred.
• Two+ years professional experience in health care, managed care, or insurance.
• Strong interpersonal and communication skills.
• Effective time management in a fast-paced environment with changing priorities.
• High level understanding of confidentiality and HIPAA requirements.

Responsibilities

• Monitors and manages utilization management reports (Payer End of Day, UM list, Discharge Log, Discharge Disposition).
• Monitors and manages EPIC work queues and updates EPIC with authorization/denial information.
• Supports the Clinical Resource Management Nurse with denials, appeals, and physician advisor communication.
• Triages and routes department calls, voicemails, faxes, and secure messages.
• Communicates with payers, case management, medical records, and other departments; scans/documentation in EHRs.

Skills

Interpersonal skills

Time management

Organizational skills

HIPAA knowledge

Education

High School Diploma

Medical Administrative Assistant certification

Tools

EPIC

Job description

Location Detail: 1290 Silas Deane Hwy Wethrsfld (10181)

Shift Detail: Monday thru Friday, 8a-430p, no weekends and no holidays

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment.

Position Summary

The Clinical Resource Management Associate is an integral part of the Care Management team. The Clinical Resource Management Associate’s focus is on providing support and coordination of utilization management services for the utilization management department.

Position Responsibilities

• Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers.
• Monitors and manages assigned EPIC work queues.
• Updates EPIC with authorization and denial information.
• Provides the Clinical Resource Management Nurse with support for denials, appeals, and physician advisor communication.
• Retrieves, manages and/or triages department phone calls, voicemails, fax requests and Tiger Texts.
• Communicates with payers, case management, medical records, and other departments.
• Scans and uploads documentation into the electronic health records.
• Performs routine and administrative tasks within the scope of non-licensed personnel.
• Manages Certification Email process.
• Other duties as assigned by supervisor

Qualifications

Education

High School Diploma, Medical Administrative Assistant certification preferred

Experience

Two+ years professional work experience in health care, managed care, or insurance.

Knowledge, Skills And Ability Requirements

• Strong interpersonal and communication skills
• Effective time management skills, able to work in a fast-paced environment with changing priorities
• Effective organizational skills
• High level understanding of confidentiality and HIPAA requirements

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.