Utilization Management Assoc / Clinical Resource Management

Hartford Healthcare•Wethersfield, CT

About The Position

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