Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible for assisting with the coordination of case management clients, utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers and members. This position is not responsible for providing care to patients.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

• Receives medial reviews and pended claim requests and data enters it into IDX.
• Prepares paperwork for RN or MD review.
• Communicates the results of the review to the requestor.
• Answers the utilization management phone and fields calls for the case managers.
• Assists providers and members by quoting benefits, verifying eligibility and answering questions about appeals.
• Creates a case in IDX for all hospital admissions.
• Assists the concurrent review nurse in requesting clinical reviews from the hospital case managers.
• Verifies eligibility and creates cases in IDX for all high risk or potential high risk members.
• Mails letters and education information to members.
• Creates, maintains, updates and files all case management charts.
• Maintains master case management list.

Knowledge / Skills / Abilities

• Demonstrated potential ability to perform the essential functions as outlined above.

• Demonstrated human relations and effective communication skills.

• Demonstrated computer literacy.

• Ability to handle highly sensitive and confidential issues in a professional manner.

• Ability to prioritize and organize tasks.

Qualifications

Qualifications

Required

• Two years of ICD-9, CPT coding or managed health care experience or education equivalency.
• Previous experience in a utilization review setting.
• Completion of a hospital provided Medical Terminology course within six months of hire.

Qualifications (Preferred)

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements