The Insurance Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse, physicians, staff and other health care professionals. Interacts with internal and external providers to review and monitor members’ utilization of health care services with the goal of maintaining high-quality cost-effective care.
Works collaboratively with staff to obtain information from clinical reviews and medical records in order to provide the appropriate communication for authorization of medical services and procedures. Collaborates on system-wide quality improvement/performance improvement. Per Diem- Insurance Specialist to assist with authorizations for Substance abuse and Mental Health Service lines
Initiates and ensures authorizations for all admissions Extracts meaningful data from the medical record of identified patients Processes electronic communications within identified process standards Actively participates in quality activities by communicating and coordinating with the care management team in the development of tools for optimal consumer outcomes and report findings Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified process standards Reviews any service denials and gathers necessary supporting documentation from chart audits and follows up according to procedures Provides external notifications of discharges and external post-acute transfers Clarifies health plan medical benefits, policies and procedures for members, physicians, medical office staff, contract providers, and outside agencies Actively participates in the discussion and notification processes that result from the clinical utilization reviews with the facilities undefined Education
High School Diploma / Associates degree in a healthcare related field preferred. Experience
One year experience in a healthcare environment utilizing medical terminology or have completed a college level course in medical terminology. One year of case management, utilization review/billing or coding experience preferred.undefined Organization Highlights: Our Trinity Health Culture: Our staff know, understand, incorporate & demonstrate our Trinity Health Mission, Values, Vision, through their actions, behaviors, practices & decisions.
Our Unit practice counsels, and open-door guiding principle gives all our employees a voice. Professional Environment of Care: Practice in an environmentally safe, professional & healthy atmosphere. On campus parking for only $6/pay.
Comprehensive benefit packages available through Trinity Health, including medical, dental, vision, paid time off, 403B, education assistance, onsite fitness center and option for daily pay. Professional Development: We offer a robust education program, a generous tuition reimbursement allowance. Our collaborative culture encourages individual interests, while our leaders ensure we stay prepared for the evolving landscape of health care.
We also support job share opportunities to promote flexibility, satisfaction, and continuous development. Work/Life: Scheduling options to balance work/life/school and recreational calendars. Mission Statement: We, St Joseph’s Health and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
Vision: To be world-renowned for passionate patient care and outstanding clinical outcomes. Core Values: In the spirit of good Stewardship, we heal by practicing Justice in fostering right relationships to promote common good, Reverence in honoring the dignity of every person, Excellence in expecting the best of ourselves and others; Integrity in being faithful to who we say we are.
$23.40 - $33.70 Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The
may also vary within the stated range based on location Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.