As a Utilization Management Assistant this role collaborates and coordinates with all members of the health care team, patient and family (or significant others) to coordinate and ensure timely and efficient delivery of required workflow, services and tasks to result in:
• Support of positive patient health care outcomes
• Increased patient/health care team outcomes and satisfaction
• Improved inpatient throughput and appropriate length of stay
• Improved communication, awareness and adherence to regulatory requirements associated with utilization
• Support for inappropriate level of care and decreased inpatient bed day denials
• Continuity and coordination of care
• Appropriate and timely authorization for level of care
• Decreased denials
• Appropriate reimbursement
• Supports UM process through accurate and timely communication of review information recorded in MIDAS or Allscripts Care Manager and associated systems to insurance companies including uploading reviews into payer website as required and phone reviews. Remains current with regulatory and internal requirements. 25%
• Performs daily follow-up with payer to obtain authorization. 25%
• Records all communication with payer according to department standards including date and time of communication, and payer contact information as required by department policy. 25%
• Timely and accurate requests to PAS for registration change to match physician order under the direction of manager or UM Nurse. 15%
• Notifies UM Nurse of concurrent denial or potential denial as the denial is received so the UM Nurse has the opportunity to provide additional information to support authorization.
*This role may encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.