Utilization Management Assistant

Job Title & Specialty Area: Utilization Management Assistant

Department: Utilization Management

Location: Children's Health
- Dallas

Shift: Full-time;
Monday through Friday

Job Type: Remote, however onsite attendance is required once a month and/or as needed for team meetings, training sessions, or other business-related needs

At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.

Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being.

Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.

Secretarial, clerical and support duties for the Utilization Management department. This position collaborates with utilization review nurses to communicate criteria for admission, continued stay and discharge to payors.

• Identify and prioritize tasks received from nurse Utilization Reviewers. Responsibilities may include but are not limited to assisting in faxing initial, concurrent or discharge reviews to insurance companies, documentation of information submitted/received by phone or fax from insurance companies into EPIC, the management of phone lines, faxing of clinical information, process incoming faxes, scanning of documents and other clerical duties as deemed necessary to assist with the facilitation of Utilization Management functions.
  
  Tasks will be performed with accuracy, correct format, grammar, punctuation and spelling.
• Communicate progression and completion of tasks to Utilization Review nurses. Communicate and document conversations with internal and external providers in EMR. Inform team members of denials and potential denials so appropriate action can be taken by Utilization Review nurse.
• Respond to insurance requests for clinical reviews and EHR notifications within time frame designated by contractual obligations. Contact Utilization Review nurse when reviews are not documented. Assist with ensuring length of stay has been authorized through monitoring of approved days. This is to be done by calling/faxing discharge dates, inputting approved length of stay into EPIC.
• Generates and submits EPIC reports specific to third party payers.
• Utilization Management Assistant is accountable for maintaining departmental productivity, quality metrics and completing assigned tasks in compliance with regulatory and departmental requirements. Must follow all HIPPA rules and regulations when providing PHI to internal and external providers. This includes but not limited to the verification of phone and fax numbers, confirmation of appropriate receipt and appropriate identification of person information is shared with.
• Maintains daily contact with Utilization Management Team Leader, Utilization Management Nurse, Denial Specialist Nurse, Utilization Management Team Leader, and Patient Access Services.
• Assist with documentation in various departmental databases. Audit, run and review reports relevant to Utilization Management as requested to ensure accuracy of information and gather statistics for reporting purposes.
• Other task and assignments as necessary.

• At least 1 year Hospital and/or Insurance Industry Experience Required
• At least 2 years Hospital and/or Insurance Industry Experience Preferred

• High school diploma or equivalent Required

• Medica…