Sinai Hospital's Utilization Review operates as a distinct specialty service line of physician advisors, nurses, and support staff who ensure hospital stays are clinically appropriate and fully covered by the patient's insurance. The team focuses on appropriate resource use, operational efficiency, and timely patient services while maintaining or improving quality of care. JOB
The Utilization Review Assistant is responsible for performing administrative and operational functions needed for the Utilization Review Department of Care Management and ensures excellent communication with third party payors and internal revenue cycle partners. This position is a primarily remote position and will come onsite to cover Admin Asst. when off.
Efficiently and effectively assists with the daily operations for the Utilization Review functions of Sinai Hospital of Baltimore. Communicates relevant information effectively to healthcare team, third party payers and internal revenue cycle partners. Manages payor calls and facilitates communication between payors and UR nurses.
Faxes clinical reviews and updates to insurance companies when needed. Maintains, updates, and files insurance lists. Maintains logs for insurance, denials and appeals.
Maintains Utilization and Appeals filing system. Accesses online payor portals for authorizations and denials and letters. Completes Livanta appeals.
Receive Notice of Eligibility and logs information. Upload clinical information to Telligen/ Qualitrac. Performs data system entry and reporting daily.
Back-up to the Care Management Administrative Assistant the following duties will be assigned: Organizes day to day departmental functions and acts as a care management departmental resource. Notifies leadership of operational problems. Maintains copies of letters sent to the patient and physicians in the Care Management Drive.
Formal working knowledge: equivalent to an Associate's degree (2 years college) preferred 1-3 years of administrative experience required Patient registration experience is strongly preferred Must Live in One of the Following Districts/States: District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia
$17.00 to $24.75 Based On Experience
Medical, dental, and vision coverage starting the first of the month after hire, plus wellness programs and mental health support 403(b) retirement plan with employer match, pension, and life and disability insurance Tuition reimbursement toward advanced degrees and specialty certifications Generous paid time off, fitness discounts, and free on-site parking About Sinai Hospital Sinai Hospital of Baltimore is a nationally recognized academic medical center, a designated Level II Trauma Center, and the largest community hospital in Maryland.
As part of LifeBridge Health - one of the region's most comprehensive healthcare systems - Sinai delivers advanced care with a mission to improve the health of the communities we serve, and to take care of the people who take care of patients. About LifeBridge Health LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to "improve the health of people in the communities we serve." Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care.
With over 14,000 employees, 130 care locations, and two million annual patient encounters, we combine strategic growth, innovation, and deep community commitment to deliver exceptional care anchored by five leading centers in Maryland. Our organization thrives on a culture of CARE BRAVELY-where compassion, courage, and urgency drive every decision, empowering teams to shape the future of healthcare. LifeBridge Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex or sexual orientation and gender identity/expression.
LifeBridge Health does not exclude people or treat them differently because of race, color, national origin, age, disability, sex or sexual orientation and gender identity/expression.