Utilization Review Specialist Position Available In Caddo, Louisiana

Utilization Review Specialist 3.0 3.0 out of 5 stars 2600 Greenwood Road, Shreveport, LA 71103 UTILIZATION

REVIEW SPECIALIST

Purpose of Job Position:

Responsible for ensuring appropriate communication with third-party payers to authorize hospital stays. Gathers clinical information for submission to complete timely, high-quality initial and continued reviews. Communicates this information with providers, payors, Floor Case Managers, and appropriate Business Office staff. Works to avoid any hospital stay denials with third-party payers.

Major Duties:

Properly utilize the electronic medical record to generate daily worklists that are accurate and up-to-date. Performs high-quality initial and subsequent reviews and submits information timely to third-party payers to obtain authorization for hospital stays. Upon identification of possible denials, forward information to the appropriate business office staff members and supervisor. Contact third-party payers throughout the admission and after the patient is discharged if needed to determine the number of approved/denied days. Complies with federal and state regulations regarding utilization review functions and scope of practice. Utilizes departmental policies and procedures to complete work in a timely and high-quality manner. Adheres to health system standards to ensure confidentiality of patient and department information. Utilizes all available methods for communicating information up to and including telephone, fax, intranet, internet, and e-fax. Maintains daily contact with case managers, registration staff, precertification, the business office, and providers as appropriate. Proactively follow up with third-party payers to determine information needs and the status of assigned claims. Provides information to third-party payers, home health agencies, post-acute service providers, government agencies and others applicable to utilization review requests and determinations. Submits all reports and data requested in a timely manner. Attends and participates in department meetings. Displays a caring and courteous attitude and represents the health system in a positive manner to all people. Assume responsibility for your own continuing education. Adheres to department and hospital dress codes, safety policies and procedures. Compliance with the policies and procedures of the Willis-Knighton Health System Code of Conduct and service quality standards Compliance with patient safety and quality initiatives as appropriate for job description. Employee will consistently and effectively use the

C.I. CARE

framework when interacting with patients, guests, and colleagues.

QUALIFICATIONS

Degree in healthcare-related field preferred 2 years of clinical experience preferred Experience in precertification and authorizations preferred.

Competent in the following:

Effective communication Problem-solving Stress management Computer skills Attention to detail Demonstrates flexibility Ability to express ideas both verbally and in writing

Location:

WK Medical Center – 1 •

Care Management Schedule:

Full-Time, Day, 0730-1600