Sanford Health Senior Utilization Management Specialist - Clinical Risk/Pt Relations in Bemidji, Minnesota
Job Title: Senior Utilization Management Specialist | Clinical Risk/Pt Relations | Bemidji
Department : Clinical Risk/Pt Relations
Job Schedule: Full Time
Hours Per Shift: 8 hr
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.
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.
Currently licensed with the applicable State Nursing Board and/or possess multistate licensure privileges as required by position. Other education required and/or preferred
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Job Function: Health Services & Clinic Administrative Leadership
Job Schedule: Full Time
Req Number: req11746