Utilization Review Tech - #1401368

Job Details

Description

Responsibilities:

Manages client’s authorizations (units/sessions) for services and submits requests for initial and additional authorizations and communicates authorization information and requirements to the appropriate clinical and/or administrative staff.

Participates in and provides assistance with tracking data correlated with department quality performance.

Prepares and maintains appropriate records and/or documents and submits reports as required.

Provides assistance and coordination with other UR departments to maximize efficiency

Manages Failed Claims/Failed Activities and obtaining all insurance eligibilities daily.

Completes UR Admissions/Discharges in the electronic medical record

Assists with preparing documentation for appeals and hearings as needed.

Prepares and maintains appropriate records and/or documents and submits reports as required.

Reviews and certifies patient stays and need for any length of stay extensions in accordance with commercial insurance and governmental agency standards – Inpatient Programs.

Assists with obtaining initial Primary Care Physician Referrals as needed and obtains continuing Primary Care Physician Referrals – Inpatient and Sub-Acute Programs.

Performs other related duties as assigned.

Qualifications

Bachelor’s Degree in Social Work or related field preferred; relevant work experience may be substituted for education

One-year admissions or UR experience, or related field; knowledge of length of stay guidelines is preferred.

Good writing skills, computer skills, and experience with Microsoft applications

Must be physically capable to receive verbal and written directions

Must be willing and able to work with all patients of Methodist Family Health, regardless of gender

Must have good auditory, visual and olfactory ability

Must be able to maintain effective audio, visual discrimination and perception needed for making observations, communicating with others, reading and writing, and operating office equipment and other treatment equipment

Must be able to use a telephone to communicate verbally and a computer to communicate through written means, to review information and enter/retrieve data, to see and read characters on a computer screen, chart or other treatment items

Requires the strength and stamina to perform clinical duties

Flu shot is mandatory and required for all positions (subject only to qualified exemptions).

COVID-19 vaccination and Flu vaccination are mandatory and required for all positions (subject to qualified exemptions).

Other: The individual employed in this position may accept other reasonable assignments, which may be necessary, for efficient operation of assigned programs as there is time and opportunity.

Job descriptions are not intended, nor should be construed, to be all-inclusive lists of all responsibilities, skills, efforts or working conditions associated with a job. While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from particular jobs and to assign other duties as necessary.

When an employee performs two or more different jobs, for which different straight time hourly rates are established, the employee will be paid during overtime hours as a rate not less than one and one-half time the hourly rate established for the type of work, he or she is performing during the overtime hours.

Level One - Full Access

Ongoing regular access to PHI of all forms while the employee is on duty and performing within the scope of his or her job as defined by the employee's job description, and Policy and Procedure. "Such access must be for cause, consistent with job responsibilities and related to patients, claims, audits, reviews and other legitimate business purposes." (e.g. Physicians, nurses and other clinicians).