Utilization Management Coordinator - Financial Clearance Center

Job Title: Utilization Management Coordinator | Financial Clearance Center | Fargo

City: Fargo

State: North Dakota

Department *: * PATIENT ACCESS MANAGEMENT

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOB SUMMARY

Concurrently and retrospectively monitors the utilization of resources, risk management and quality of care for patients at Sanford Health. Collection of clinical information necessary to initiate commercial payor authorization and continued stay review. Recommend previous hospital experience with knowledge of hospital procedures, regulations, and commercial payors. Ability to interact on an interpersonal basis with both physicians and nursing staff. Ability to keep accurate records. Ability to communicate both orally and in writing. Basic knowledge of typing and filing. Experience with computer use, and specifically, Windows software. Must be able to work with growth and development needs of pediatric to geriatric populations. #featuredjob

POSITION RESPONSIBILITIES

Full-time, 40 hours a week. The UM Coordinator will be required to work primarily day hours, but may be required to work some evenings to ensure contact with case managed members. Manage and complete authorization within the work queues; Assist with and manage insurance denials; Review medical policies and review for medical necessity for scheduled procedures; Verify insurance coverage through established methods; Perform other duties as assigned. Works in an office environment and basically telephonic/computer; May occasionally have face to face contact with members in the office setting.

DEPARTMENT DETAILS

Applies available tools and resources to work efficiently. Assesses common problems and associated approaches to resolution. Delivers written and oral communication, responds to questions and concerns, and produce specific outcomes and impact. Demonstrates an ability to meet own responsibilities. Explains the best practices, key processes and benchmarks for a specific insurance product. Follows-up with customers to answer questions and ensure satisfaction. Maintains a sense of urgency and a positive attitude. Maintains sense of commitment to success, personal achievement and satisfaction. Operates and maintains standard office equipment such as copiers, faxes, phones. Presents a professional image, especially when dealing with customers.

QUALIFICATIONS

Appropriate education level required in accordance with licensure. Seven years of relevant experience, superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required. Specific background or experience in healthcare reimbursement, insurance industry, and/or authorization experience would be critical to the success in this role and preferred. Currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges, or Registered Health Information Technician (RHIT) or a coding certification (CCS, CCSP, CPC, CPCH, COC, CAC) required. Obtains and subsequently maintains required department specific competencies and certifications.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing. Every day, we show that commitment by delivering the highest quality of care to the communities we serve. We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases. We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .
In compliance with federal law requiring employers to verify new employees' U.S.
employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .

City: Fargo

State: North Dakota

Job Function: Nursing

Job Schedule: Full Time

Shift: Days

Req Number: req21970