Utilization Management Assoc / Clinical Resource Management

Hartford Healthcare•Wethersfield, CT

About The Position

Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common\: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system. Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment. Position Summary: The Clinical Resource Management Associate is an integral part of the Care Management team. The Clinical Resource Management Associate’s focus is on providing support and coordination of utilization management services for the utilization management department.

Requirements

High School Diploma
Two+ years professional work experience in health care, managed care, or insurance.
Strong interpersonal and communication skills
Effective time management skills, able to work in a fast-paced environment with changing priorities
Effective organizational skills
High level understanding of confidentiality and HIPAA requirements

Nice To Haves

Medical Administrative Assistant certification preferred

Responsibilities

Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers.
Monitors and manages assigned EPIC work queues.
Updates EPIC with authorization and denial information.
Provides the Clinical Resource Management Nurse with support for denials, appeals, and physician advisor communication.
Retrieves, manages and/or triages department phone calls, voicemails, fax requests and Tiger Texts.
Communicates with payers, case management, medical records, and other departments.
Scans and uploads documentation into the electronic health records.
Performs routine and administrative tasks within the scope of non-licensed personnel.
Manages Certification Email process.
Other duties as assigned by supervisor