Sanford Health Senior Utilization Management Specialist - Clinical Risk/Pt Relations in Bemidji, Minnesota

Job Title: Senior Utilization Management Specialist | Clinical Risk/Pt Relations | Bemidji

City: BEMIDJI

State: Minnesota

Department : Clinical Risk/Pt Relations

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOBSUMMARY

Organizes, plans, and coordinates a systematic, organization-wide approach to utilization management to facilitate achievement of fiscal outcomes. Coordinates activities for the implementation and ongoing evaluation and improvements relating to the utilization management process, management of denials, appeals, and facilitating process related to these activities. Collaborates with the Reimbursement, Health Information Management, Patient Financial Services, Denials/Appeals, Corporate Contracting, Information Technology, Medical Staff and other departments regarding Utilization Management and Denials/Appeals to ensure appropriate linkages between documentation, coding, chargemaster entry and billing practices. Educates providers regarding trends, external regulations and internal policies that effect resource utilization. May work with toddler through geriatric age groups.Processes organizational, management and strong verbal and written communication skills, dynamic and tactful interpersonal skills, particularly in relating to physicians, other health care professionals and top level management, the ability to organize complex systems of data and the ability to work effectively with both people and data including data management, retrieval and analysis skills. Knowledge of statistics and statistical data displays. Personal commitment to quality of care.

POSITION RESPONSIBILITIES

Shift: FT: Days & Weekends

Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of all hospital admissions.

Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records.

Coordinates and supervises the activities of the Utilization Review Department.

Refers to the Utilization Review Physician Advisor all cases that do not meet established guidelines for admission or continued stay.

Assists the Utilization Review Committee in the assessment and solution of identified utilization review problems.

Maintains a liaison with the Social Service Department to facilitate timely discharge planning.

Compiles monthly reports and statistics for presentation to the Utilization Review Committee.

QUALIFICATIONS

Currently licensed with the applicable State Nursing Board and/or possess multistate licensure privileges as required by position. Other education required and/or preferred

About SanfordHealth:

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 1-877-243-1372 or send an email totalent@sanfordhealth.org.

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employees' U.S. employment eligibility, Sanford participates in E-Verify. To learn more click here forEnglish Versionor here forSpanish Version.

City: Bemidji

State: Minnesota

Job Function: Health Services & Clinic Administrative Leadership

Job Schedule: Full Time

Shift: Days

Req Number: req11746