"Utilization Management Assistant (Patient Services Intermediate)"

A cover letter is required for consideration for this position and should be attached as the first page of your resume. The cover letter should address your specific interest in the position and outline skills and experience that directly relate to this position.

Essential:

1. Data entry of clinical review information for online authorizations into multiple web sites for multiple payers
2. Maintain accuracy of payer grid by notifying appropriate staff and Revenue Cycle of changes in fax numbers, etc.
3. Obtain authorization for services from third party payers and notify RN Case Manager of issues with authorizations
4. Enter authorization numbers and approval days/dates into the appropriate software system for utilization management and electronic medical records.
5. Fax clinical reviews to payers, maintain confirmations, document completely and accurately activities performed
6. Interact with payers during phone conversations, provide discharge dates and patient status information
7. Respond to email from Billing Department with requests for authorization numbers or patient status
8. Answer departmental phones/messages and distribute to RN Case Managers mindful of coverage assignments.
9. Assist in obtaining authorization for inpatient and observation care by providing payers with clinical information via fax, autoroute, and web-based programs, for example, E-Referral, Navinet, Pnote
10. Demonstrate ability to use multiple computer programs to research patient information
11. Willingly and consistently offer assistance to staff especially when patient census is high
12. Actively participate in learning new technologies
13. Provide notification to out of state insurers when requested by case managers
14. Other duties as assigned

DAILY WORK DUTIES

1. Scheduling Physician "Peer to Peer" (P2Ps) Review Meetings and documenting outcomes
2. Insurance Alert Changes from software system for utilization management: notify RN CM if additional clinicals are required
3. For web-based programs, for example, P Notes for Blue Cross PPO and Traditional and E Referral for Blue Cross Network (BCN), input patient data, submit initial review with InterQual criteria subset (1511 work queue)
4. Utilize Accuroute a software fax program effectively
5. Authorizations/Certifications - obtained by phone calls, faxes, payer contact screen
6. Combining Admissions - documenting in MiChart, submit codes for billing
7. Telephone notification of out of state insurers, providing ICD codes (clinical follows)
8. Navinet - Online portal to start process for Aetna, Cigna, BC Complete, Amerihealth, Priority to obtain authorizations and check for updates
9. General faxing
10. DCPA - authorizations pended, discharge information required
11. 223 List in MiChart to complete input of auths/certs
12. Follow up on emails from professional billers by editing patient information in the utilization management software.
13. Distribution of cases on the unassigned worklist

Required Qualifications

• High School Diploma or GED.
• Minimum 3 years of experience.
• Analytical skills are necessary in order to assess urgency and complexity of workflow
• Proficiency in medical terminology
• Proficiency in use of computer technology and experience with Microsoft Office software applications
• Strong interpersonal communication skills, including problem solving and decision making
• Demonstrated telephone communication skills required
• Experience in a health care environment
• Ability to work well with physicians and other health care providers
• Strong customer service and ability to work in a team environment

Preferred Qualifications

• Knowledge of UR processes and different levels of care within a hospital
• Knowledge of the University of Michigan Hospitals and Health Systems computer software systems
• Knowledge of the University of Michigan Hospitals and Health Systems Policies and Procedures

Work schedule may vary, typically, Monday through Friday with some weekend and holiday coverage. Hours are 9:00 am to 5:30 pm

This position is covered under the collective bargaining agreement between the U-M and the Service Employees International Union (SEIU), which contains and settles all matters with respect to wages, benefits, hours, and other terms and conditions of employment.