Utilization Management Assistant

ChristianaCare•Wilmington, DE

4d•Onsite

About The Position

Our Utilization Management department located in Wilmington, DE is looking for a full-time Utilization Management Assistant to use internal and external resources to resolve social, emotional, and environmental needs by verifying benefits, obtaining insurance authorizations, placing orders to vendors and accurately entering data into clinical information systems. The ideal candidate will be well organized, detail oriented and can multitask. Candidate to complete tasks and duties within a prescribed timeline. Strong computer skills as well as good verbal and written communication skills.

Requirements

High School diploma or equivalent required.
Four years progressively responsible administrative support to an administrator or manager.
Knowledge of ChristianaCare and departmental policies, procedures, and standards
Knowledge of Joint Commission requirements and standards
Proficient with Microsoft Word, Excel, and PowerPoint
Ability to function as a member of an interdisciplinary team.
Ability to learn and understand basic medical terminology.
Understand HIPPA/Privacy regulations with patient medical records
Knowledge of PC including EMR applications
Typing proficiency
Strong organization and superior communication skills are required.
Ability to use telephone communication systems
Ability to orally communicate, effectively.
Ability to identify issues, troubleshoot problems and find effective solutions
Ability to adapt to changing priorities and manage multiple tasks simultaneously
Stability to work under emotional, time, and volume pressure

Nice To Haves

Knowledge of the insurance authorization process is preferred.
Five years of experience in a support role in Case Management/Utilization Management experience preferred
Five years of experience in administrative support in Health Care preferred

Responsibilities

Perform duties adhering to the ChristianaCare Core Values and Behaviors guided by Excellence and Love.
Provides administrative support to the team; assists with copying, faxing, form completion, addressing emails and Medicare letters by department standards.
Assists with completion of Utilization Management duties including providing clinical information to insurance companies to obtain authorizations and updating patient records timely.
Assists in contacting patient and families to discuss level of care, status changes, and appeal options with insurance.
Assist in scheduling phone calls and meetings for members of the UM team with payer representatives.
Establish a knowledge base for medical necessity requirements for all major insurance companies.
Assists with routine calls, emails, faxes from insurance companies.
Assists with general support services and office coverage as staffing needs dictate.
Establishes collaborative relationships with Utilization Managers, Care Managers and other health care staff to effectively and efficiently complete necessary services.
Enters accurate data, authorization/referral entries into computer system as directed by team in an accurate and timely manner.
Calls insurance companies for authorization, benefit verification and coverage information as necessary.
Execute proper use of the telephone and voice mail systems.
Incorporates services standards for telephone contact into daily activities
Provides superior customer service to providers and members.
Communicates effectively with departments in the Christiana Care Health System.
Performs specific projects as directed by Supervisor and/or Director.
Acquires new skills needed for performing job functions as the healthcare/delivery system changes.
Participates as an active member of the team, offering suggestions and recommendations for more effective and efficient operations.
Maintains confidentiality of patient information.
Participates in seminars/workshops and in-service education regarding new resources.
Adheres to Christiana Care policies and procedures including, but not limited to, annual Fire and Safety, Infection Control procedures and demonstrates core values.
Perform assigned work safely, adhering to established departmental safety rules and practices.
Addresses and/or reports to Managers/Director, in a timely manner, any unsafe activities, conditions, hazards or safety violations that may cause injury to oneself, other caregivers, patients and visitors.
Scheduling and calendar management – managing appointments and meetings for leaders
Maintaining organized filing systems, both electronic and physical and retrieving information as needed
Meeting coordination – preparing meeting agendas, taking minutes, and ensuring logistics are handled effectively
Office management – ordering office supplies
Supports the onboarding of new hires by arranging necessary accesses, vocera, IT needs, desk
Monitor IT equipment needs; order necessary equipment; enter IT tickets as needed
Performs other related duties as required