What are the responsibilities and job description for the Manager-Utilization Review and Insurance Verification, Palos Community Hospital position at Palos Hospital?
Description
The Manager, Utilization Review and Insurance Verification position reflects the mission, vision, and values of Northwestern Medicine, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
This position will manage and oversee daily operations of insurance verification & utilization and review nurses through effective use of systems, staff management, and reporting.
Responsibilities:
- Responsible for all verification activities including precertification and authorization.
- Coordination of services to facilitate the achievement of cost and quality patient care and appropriate use of resources.
- Meets on a regular basis with staff and other office personnel.
- Coordinates and supervises distribution of daily utilization and review nurse duties.
- Provides adequate staffing and scheduling for employees. Works understaffed shifts as needed.
- Assures that the insurance verification of all applicable accounts is maintained at approximately 5 days prior to date of service.
- Handles routine personnel issues in a timely manner including hiring recommendations, and verbal and written counseling statements.
- Identifies and reports data system problems affecting insurance verification: assists DIS in rectifying any issues.
- Evaluates the work performance of all insurance verification staff providing training and education as necessary.
- Communicates all changes regarding insurance verification procedures to all appropriate staff both within and outside the business office.
- Keeps up to date with regulations, legislation, and all managed care contracts that effect utilization and review activities and verification and reimbursement procedures.
Preferred:
- Previous knowledge of managed care contracting
- Registered Nurse strongly preferred
Qualifications
Requirements:
- Bachelor's Degree and/or 5 years of supervisory experience in the hospital setting
- Minimum of 5 years' experience working in hospital business office
- Problem resolution while maintaining good public relations.
- Experience in dealing with difficult situations.
- Excellent communication skills
Equal Opportunity
Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
