What are the responsibilities and job description for the Utilization Management Assistant position at Talent?
Overview
CHI St. Vincent a regional health network serving Arkansas is part of CommonSpirit Health. We have served Arkansas since 1888 with a history of many firsts. Together with more than 4500 coworkers 1000 medical staff and 500 volunteers we consistently receive praise for care advancements. CHI St Vincent North has 69 beds and offers a small-town feeling of family and camaraderie. We have a strong neuro and cardiac focus.CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. CHI St. Vincent provides you with the same level of care you provide to others. We care about our employee well-being and offer benefits that complement and support your work / life balance.We offer the following benefits to support you and your family : Free Premium Membership to our Care@Work program to help employees with child care pet care senior caregivers housekeepers & more.Health / Dental / Vision InsuranceFlexible spending accountsVoluntary Protection : Group Accident Critical Illness and Identity Theft Adoption AssistanceEmployee Assistance Program (EAP) for you and your familyPaid Time Off (PTO) Tuition Assistance for career growth and developmentMatching 401(k) and 457(b) Retirement ProgramsWellness Programs
The CommonSpirit Utilization Management Assistant receives, processes, facilitates and documents all payer communications. This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third party payers. The Utilization Management Assistant supports the Utilization Management Hub department by recognizing trends and opportunities for process improvement and reporting those to leadership. The Utilization Management Assistant performs these duties with a high degree of accuracy utilizing critical thinking skills and in compliance with hospital policies, standards of practice and Federal and State Regulations.
Employees are accountable for demonstrating a strong commitment to promoting quality every day by demonstrating our organizational values of : Compassion, Inclusion, Integrity, Excellence, and Collaboration.
Responsibilities
- Receives, sends and documents payer requests for clinical documentation.
- Receives and documents payer authorization and communications including but not limited to concurrent denials.
- Coordination of peer to peer conversations, as applicable.
- Review surgery schedule to verify correct authorization is documented, if applicable.
- Identifies accounts lacking authorization and follows up with payers, as needed.
- Communicates with interdepartmental staff regarding payer documentation requests.
- Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
- Identifies and reports trends to department Leadership.
- Utilizes payer related reports from Care Management software, where applicable.
- Collaborates with and supports the UM team including but not limited to UR and Denials RN.
- Contributes to the identification of opportunities for process improvement.
- Supports administrative departmental functions, as assigned.
Qualifications
Preferred
