Utilization Management Resource Specialist

MedStar Health; Somerville (MA); Remote; USD 45,000 - 65,000; Full time

Job summary

A leading healthcare organization seeks a Utilization Management Resource Specialist to support utilization review processes. The ideal candidate will have strong communication skills, 2-3 years of related experience, and the ability to collaborate effectively across departments in a fast-paced environment. This full-time remote position offers flexibility and requires occasional weekend work.

Qualifications

• 2-3 years of related experience preferred.
• Familiarity with medical terminology.
• Ability to maintain effective working relationships with patients/families.

Responsibilities

• Provides support to the utilization management case managers.
• Conducts daily data collection per direction of UM leadership.
• Manages incoming faxes/emails and documentation.

Skills

Communication

Collaboration

Customer Service

Advocacy

Crisis Intervention

Assessment

Interpersonal Skills

Education

High School Diploma or Equivalent

Associate's Degree Related Field of Study

Job description

Reporting to Manager for Utilization Management, the Utilization Management Resource Specialist (UMRS) works collaboratively with the Utilization Management Case Managers (UMCM), Clinical Operations, Revenue 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 all 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 all 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.

Education

• High School Diploma or Equivalent required
• Associate's Degree Related Field of Study preferred

Experience

• 2-3 years of related experience preferred

Knowledge, Skills, and Abilities

• Familiarity with medical terminology.
• Familiarity with community services/resources.
• Ability to maintain effective working relationships with patients/families.
• Knowledge of current community resources.
• Strong assessment and crisis intervention.
• Strong collaborative skills and a desire to work in a complex, fast-paced environment.
• Excellent interpersonal skills.
• Excellent collaboration, customer service, and advocacy skills.
• Excellent written and verbal communication skills.

Working Conditions

• This full-time remote role is Monday through Friday, with work schedules between 8 AM and 5 PM ET
• Occasional weekend work is required

Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.