Utilization Review Assistant

Renown Health; Reno (NV); On-site; USD 42,000 - 60,000; Full time

Job summary

Renown Health is seeking an administrative support professional to assist the Utilization Review RN and Utilization Management Coordinator. The role focuses on coordinating authorizations with insurers, updating EMR with notices, and facilitating timely submission of clinical documentation.

Responsibilities include verifying orders, updating patient status before procedures, and coordinating peer discussions for denials management while handling multiple fax lines and portal notifications.

Qualifications

• Proficient with Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).
• Strong written and verbal communication skills.
• Ability to collaborate across teams and departments.
• Ability to prioritize and manage multiple tasks with accuracy.

Responsibilities

• Support the Utilization Review RN and Utilization Management Coordinator in daily tasks.
• Verify provider orders and patient status prior to elective procedures.
• Coordinate peer-to-peer discussions for denials management.
• Submit clinical documentation to payors via fax in a timely manner.
• Monitor multiple fax lines and insurance portals for authorization notices.
• Collaborate with community providers to reflect accurate orders on surgical accounts.

Skills

MS Office

Communication

Critical thinking

Collaboration

EMR access (Epic)

Tools

Epic

Job description

Purpose:

This position will be the main supporting role for the Utilization Review RNs and Utilization Management Coordinators at Renown Health. Under the direction of department leadership, this position participates in the communication and collaboration with insurance payors, Internal Physician Advisors, Community Providers, and Renown staff for coordination of authorization of patient stay.

Nature and Scope:

• Supportive role for Utilization Review RN and Utilization Management Coordinator.
• Participates in communication and collaboration with insurance payors, Internal Physician Advisors, community Providers, and Renown staff for coordination of authorization of patient stay.
• Requires critical thinking, collaboration, and communication.
• Works alongside Utilization Review RN and Utilization Management Coordinators to ensure the following:o Ensure authorization notices are placed in electronic medical records.o Verify provider orders and patient status are updated appropriately and accurately prior to admission for elective surgeries.o Coordinate peer-to-peer discussions between providers for denials management.o Support the Utilization Review RN with timely submission of clinical documentation via fax to insurance payors.
• Manages multiple fax lines while monitoring various reports and insurance portals for authorization notifications.
• Collaborate with community providers to ensure appropriate orders are reflected on surgical accounts prior to the day or surgery.

KNOWLEDGE, SKILLS, & ABILITIES

• Must respect beliefs and values while advocating for the patient's right to self-determination and to make informed choices.
• Documents all chart and phone reviews, identifies, and communicates potentially avoidable/non-reimbursed days, and quality indicators (such as re-admissions).
• This position acquires and maintains knowledge and competencies related to the expectations of their role. Practice is aligned with the mission, vision, and goals of the Integrated Health System.
• Must be able to prioritize and assess situations while maintaining quality services under stressful conditions.This position provides clerical and support services.This position does not provide patient care

Minimum Qualifications:

Requirements - Required and/or Preferred

• Education: Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively. Understanding of medical terminology preferred.
• Experience: One-year clerical experience in the medical field preferred.
• License(s): None
• Certification(s): None
• Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Computer skills are necessary to access epic and other supporting computer applications.

Disclaimer:

The foregoing description is not intended to be, and should not be construed as, an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.