What are the responsibilities and job description for the Utilization Management Specialist position at Franciscan Health?
WHO WE ARE
With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.
- Analysis Analyzes clinical service requests from providers against evidence-based clinical guidelines.
- Data Requests Requests additional information from providers in consistent and efficient manner.
- Eligibility Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
- Prior Authorizations Reviews requests for medical necessity and refers prior authorization requests that require additional expertise to Medical Director.
- Prior Authorizations Conducts prior authorization reviews to determine financial responsibility.
- Process Improvement Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all Managed Care Plan(s), Department Policies and Procedures, State and Federal regulations and guidelines.
- Documentation Maintains complete documentation of all reviews, forms, and reports and retains in accordance with Plan guidelines and department procedures.
- Compliance Oversees compliance of utilization requirements as mandated by Plans and Department.
- Other Performs all duties and responsibilities in a manner consistent with and supportive of the mission and values of Franciscan Alliance Inc.
- Required High School Diploma/GED
- 1 year Utilization Management/HMO/PPO experience Required
TRAVEL IS REQUIRED:
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
