Utilization Management Reviewer - Full Time

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Schedule: Full Time

Summary:

• Conducts Utilization Management reviews for Princeton House patients, assigned by the Department Director. Documents in the facility-wide computer system the results of each review, conducted both internally and externally (with managed care organizations). Familiarity with Princeton House services/programs in all locations is essential.

Responsibilities:

• Perform admission review for assigned patients to determine the medical necessity and appropriateness of admission based on departmental policy and procedure. Maintain system for monitoring admissions to assure the review of extended stay and communication of such information to insurance providers/managed care companies in a timely fashion. Maintains a schedule of additional review dates for patients requiring concurrent review. This information is to be maintained in the SQL Database as per department policies and procedures. Conducts Utilization Management reviews for assigned patients, regardless of their insurance, to determine need for treatment and appropriateness of care. Discusses concerns regarding these issues with the attending physician, and if necessary, the treatment team and proactively works to resolve UM issues.

Education or Equivalent Experience:

• Masters level degree in healthcare field or significant combination of credentials and experience for the job (i.e. RN, LPN, BSW, etc.) maintaining clinical competence in specific area of expertise.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.