What are the responsibilities and job description for the Utilization Management Specialist II Full-Time position at University of Maryland Medical System?
I. General Summary
Under general supervision provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines / criteria to assess the patients need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers medical team other hospital staff physician advisors and payers.
II. Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
- Performs timely and accurate utilization review for all patient populations using nationally recognized care guidelines / criteria relevant to the payer.
- Communicates with case manager physician advisor medical team and payors as needed regarding reviews and pended / denied days and interventions.
- Supports concurrent appeals process through proactive identification of pended / denied days. Implements the concurrent appeals process with appropriate referrals and documentation.
- Ensures appropriate Level of Care and patient status for each patient (Observation Extended Recovery Administrative Inpatient Critical Care Intermediate Care and MedSurg)
- Reviews tests procedures and consultations for appropriate utilization of resources in a timely manner
Qualifications :
III. Education and Experience
IV. Knowledge Skills and Abilities
V. Patient Safety
Ensures patient safety in the performance of job functions and through participation in hospital department or unit patient safety initiatives.
Additional Information :
All your information will be kept confidential according to EEO guidelines.
Compensation :
Pay Range : $34.01 $47.18
Other Compensation (if applicable) :
Review theUMMS Benefits Guide
Remote Work : Employment Type :
Fulltime
Key Skills
Abinitio,Administration And Accounting,Android,Bid Management,Inventory Management,Embedded C
Vacancy : 1
Salary : $34 - $47
