Utilization Specialist: Reimbursement & Care Liaison

Erlanger Health System; Hudson (WI); On-site; USD 50,000 - 70,000; Full time

Job summary

Erlanger Health System is seeking a utilization management professional to proactively monitor patient service utilization and optimize reimbursement for the facility.

The role involves acting as a liaison between managed care organizations and clinical staff, conducting reviews for certification requirements, and coordinating communications related to reimbursement. Experience in utilization management is preferred and clinical experience is required.

Qualifications

• High school diploma or equivalent required.
• Preferred degrees in Social Work, Behavioral or Mental Health, Nursing, or related health field.
• Clinical experience required, or 2+ years working with facility population; utilization management preferred.

Responsibilities

• Act as liaison between managed care organizations and facility clinical staff.
• Review insurance plans for certification requirements and coordinate communication on reimbursement.
• Monitor length of stay and inform staff of issues affecting stay.
• Gather and report statistics on utilization, discharges, and quality of services.
• Conduct quality reviews for medical necessity and services.

Skills

Communication

Interpersonal skills

Healthcare reimbursement

Quality review

Education

High school diploma or equivalent

Associate/Bachelor/Master in health-related field

Tools

None

Job description

Erlanger Health System is seeking a utilization management professional to proactively monitor patient service utilization and optimize reimbursement for the facility.

The role involves acting as a liaison between managed care organizations and clinical staff, conducting reviews for certification requirements, and coordinating communications related to reimbursement. Experience in utilization management is preferred and clinical experience is required.