Utilization Management Coordinator

Utah; Murray (UT); Remote; USD 42,000 - 54,000; Full time

Job summary

The University of Utah Health Plans in Murray, UT is seeking a dedicated Utilization Review Coordinator to assist with coordination of prior authorization, concurrent review, and medical necessity reviews. You will interact with providers and members, supporting UM processes and ensuring timely communications.

Ideal candidates have at least two years of health care experience or an equivalent education, familiarity with medical terminology, and prior utilization review exposure.

Qualifications

• Two years of health care experience or education equivalency.
• Understanding of medical terminology.
• Previous experience in a utilization review setting.

Responsibilities

• Receives requests for prior authorization, concurrent review, post service, or a claim review, and enters the request in the Utilization Management Platform.
• Checks eligibility, network status, procedure coverage, prior authorization status, and obtains clinical records in order to prepare authorization for RN or MD review.
• Communicates the authorization determination to the requestor and/or member.
• Answers and/or responds to calls from operational phone queues.
• Assists providers and members by confirming benefits, verifying member eligibility, quoting prior authorization status and answering questions about prior authorizations.
• Ensures timely notification of decisions to members and providers by fax, mail and telephone.
• Facilitates Utilization Management processes with Medical Review Officers, UM Nurses, hospitals, physicians and other various internal and external customers.
• Maintain understanding of business rules and regulatory requirements pertaining to UM processes and operations.
• Other duties as assigned for preservice, concurrent review, post service and claim reviews.

Skills

Health care experience

Medical terminology

Utilization review

Communication skills

Computer literacy

Education

Bachelor's degree or equivalent

Tools

CPT coding

ICD-10 coding

HCPCS codes

Job description

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, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible for assisting with the coordination of 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

Essential Functions

• Receives requests for prior authorization, concurrent review, post service, or a claim review, and enters the request in the Utilization Management Platform.
• Checks eligibility, network status, procedure coverage, prior authorization status, and obtains clinical records in order to prepare authorization for RN or MD review.
• Communicates the authorization determination to the requestor and/or member.
• Answers and/or responds to calls from operational phone queues.
• Assists providers and members by confirming benefits, verifying member eligibility, quoting prior authorization status and answering questions about prior authorizations.
• Ensures timely notification of decisions to members and providers by fax, mail and telephone.
• Facilitates Utilization Management processes with Medical Review Officers, UM Nurses, hospitals, physicians and other various internal and external customers.
• Maintain understanding of business rules and regulatory requirements pertaining to UM processes and operations.
• Other duties as assigned for preservice, concurrent review, post service and claim reviews.

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

Required

• Two years of health care experience or education equivalency.
• Understanding of medical terminology.
• Previous experience in a utilization review setting.

Qualifications (Preferred)

Preferred

• Bachelor's degree in a health-related discipline, business, or the equivalency.
• Coding (CPT, ICD-10, HCPCS and hospital billing codes).

Working Conditions and Physical Demands

• 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

Non Indicated

Multi-lingual Candidates Welcomed

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 and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations.

All qualified individuals 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 Health Hospitals and Clinics, a part of The University of Utah, is an Affinitative 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.

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 [phone] 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 [phone] or [phone] or Hospitals and Clinics Human Resources at [phone] 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 86413

Reg/Temp Regular

Employment Type PRN

Shift Day

Work Schedule Availability: Monday - Friday 8a - 5p

Clinical/Non-Clinical Status Non-Clinical

Location Name University of Utah Health Plans

Workplace Set Up Remote

City Murray

State UT

Department UIP CST 01H UUHP CLINICAL OPRN

Category Finance/Accounting

Workplace Set Up Remote