Provides administrative support to the operations of the Utilization Management Team. Performs non-clinical functions to support Utilization Management staff. Retrieves data from appropriate records in accordance with the established Utilization Management and Discharge Planning criteria, and assists with data collection and data entry.
Records data in hard copy or computer databases, and compiles findings for reporting, monitoring and evaluating purposes.
Work Experience One year of progressively responsible clerical experience required. Previous healthcare experience preferred. Education High school diploma or equivalent preferred.
Certifications/Licensure Job Specific Performance Standards The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time. Assists with Utilization Management and Discharge Planning data collection.
Collects and records data from patients’ medical records and pertinent hospital records that contain necessary information, and coordinates sending and receiving fax and phone communication under the direction of the Utilization Management Assists with data collection, entry and compilation for departmental functions. Enters information at computer workstation, in appropriate hospital computer system software. Performs non-clinical functions in support of Utilization Management such as organizing and maintaining daily paper worksheets; benefit/insurance number verification; interfacing with payers to report Utilization Review clinical reviews and obtain certifications; maintaining file for all current Medicaid authorizations and tracking retro-Medicaid cases; and other non-clinical support activities.
Faxes information per departmental policy and in compliance with HIPAA requirements. Obtains patient records from Health Information Management as needed. Assists with conducting record reviews as needed.
Maintains records in appropriate departmental files. Assists with special projects on an as needed basis: assists with data collection, entering data in Excel or Access database, and data analysis. Prepares and/or assists with preparation of miscellaneous correspondence and documents (letters, agendas, minutes, charts, reports).
Provides general clerical support including answering phones, filing, faxing and copying as needed.
Day Shift