What are the responsibilities and job description for the Utilization Review Manager position at Umpqua Health Management LLC?
The Role:
As a Utilization Review Manager, you will be responsible for ensuring that healthcare services are medically necessary, efficiently provided, and appropriately utilized. This role involves reviewing patient medical records, coordinating with healthcare providers, and ensuring compliance with regulatory and payer requirements.
Your Impact:
Performs data entry of authorization information (per policy/procedure) into web-based system as received through telephone calls, voice mail messages and emails.
Gathers and organizes clinical information for review.
Communicates authorization request status to the providers as per policy and procedure.
Writes coverage determination letters.
Works with computer/electronic medical records daily.
Perform other duties as assigned by management to help drive our Vision, fulfill our Mission, and abide by our Organization’s Values
Your Credentials:
High School Diploma or equivalent.
Experience leading a team within the healthcare industry.
Demonstrate a proficiency in computer skills – Windows, Word, Excel, Outlook, clinical platforms, internet searches
Strong knowledge of ICD 10 codes, CPT codes and medical terminology.
Excellent organizational and communication skills.
Ability to be flexible and work in a fast-paced office environment.
Ability to prioritize a high volume of work.
Medical office or hospital experience.
Excellent analytical and critical thinking skills.
Strong communication and interpersonal skills, with the ability to work effectively with healthcare providers, patients, and insurance companies.
Proficient in using electronic medical records (EMR) systems and utilization management software.
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
