Utilization Review Assistant
- Requisition ID
- 186293
- Department
- 200772 Utilization Management
- Schedule
- Full Time - Eligible for Benefits
- Shift
- Day
- Category
- Clerical & Administrative Support
Position Purpose
This position will be the main supporting role for the Utilization Review RNs and Utilization Management Coordinators at Renown Health. Under the direction of department leadership, this position participates in the communication and collaboration with insurance payors, Internal Physician Advisors, Community Providers, and Renown staff for coordination of authorization of patient stay.
Nature and Scope
• Supportive role for Utilization Review RN and Utilization Management Coordinator.
• Participates in communication and collaboration with insurance payors, Internal Physician Advisors, community Providers, and Renown staff for coordination of authorization of patient stay.
• Requires critical thinking, collaboration, and communication.
• Works alongside Utilization Review RN and Utilization Management Coordinators to ensure the following:
o Ensure authorization notices are placed in electronic medical records.
o Verify provider orders and patient status are updated appropriately and accurately prior to admission for elective surgeries.
o Coordinate peer-to-peer discussions between providers for denials management.
o Support the Utilization Review RN with timely submission of clinical documentation via fax to insurance payors.
• Manages multiple fax lines while monitoring various reports and insurance portals for authorization notifications.
• Collaborate with community providers to ensure appropriate orders are reflected on surgical accounts prior to the day or surgery.
KNOWLEDGE, SKILLS, & ABILITIES
• Must respect beliefs and values while advocating for the patient’s right to self-determination and to make informed choices.
• Documents all chart and phone reviews, identifies, and communicates potentially avoidable/non-reimbursed days, and quality indicators (such as re-admissions).
• This position acquires and maintains knowledge and competencies related to the expectations of their role. Practice is aligned with the mission, vision, and goals of the Integrated Health System.
• Must be able to prioritize and assess situations while maintaining quality services under stressful conditions.
This position provides clerical and support services.
This position does not provide patient care.
Disclaimer
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications
Requirements - Required and/or Preferred
Name | Description |
|---|---|
Education: | Must have working-level knowledge of the English language, including reading, writing, and speaking English. Understanding of medical terminology preferred. |
Experience: | One-year clerical experience in the medical field preferred. |
License(s): | None |
Certification(s): | None |
Computer / Typing: | Must possess the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Computer skills are necessary to access epic and other supporting computer applications. |
Benefits
Renown Health exists to make a genuine difference in the health and well-being of the people and communities we serve. And it is through your passion that this mission is made real every day. The relationship with employees is the foundation for success as we proceed with our strategic direction. We strive to build upon this solid partnership by offering a comprehensive and competitive benefits package that meets the diverse needs of employees and their family members.
With my CAREER Rewards there's peace of mind in knowing that Renown Health is also fighting for the most important things in your life - family, finances and future. Navigate options and make sure you are getting the most value from your Nursing career with us.
Paid Time Off
401(k) Company Match
Flexible Work Environment
Renown Health is northern Nevada's healthcare leader and Reno's only locally owned, not-for-profit health system. We are an entire network of hospitals, primary care offices, urgent care centers, lab services, medical specialties, and x-ray and imaging services - with more than 7,000 nurses, doctors and care providers dedicated to the health and well-being of our community.
For Providers: Renown Health and the University of Nevada, Reno School of Medicine (UNR Med) are affiliate partners in Nevada's first integrated academic health system. The affiliation aims to improve the health of the community, region, and state through research, medical education, and expanded clinical care. Renown physicians participate as joint faculty at UNR Med for teaching, lectures, supervising clinical rotations, and other academic activities for the education of medical and physician assistant students, residents and fellows.