Utilization Management Partner

Lehigh Valley Health Network•Pocono Township, PA

1d•Onsite

About The Position

Responsible for the compliant, accurate and timely delivery of Observation Notifications directly to patients and/or their families/representatives while hospitalized under Observation Status/Patient Class. Responsible for other payer-based forms, including but not limited to ADAR forms. Assists Utilization Management (UM) team by acting as a bridge between the patient/family/representative and the UM team, as well as the Interdisciplinary team for the purposes of communication related to health insurance communication, requirements and related information. Prioritizes coverage at largest hospital site. Works highly collaboratively with the IP Care Management team on-site. Also responsible for working collaboratively with UM teammates to perform administrative and operational functions within the UM Department. Provides support to UM teammates by ensuring appropriate communication with insurance payers as well as related documentation within payer-specified timeframes. Performs clerical duties including but not limited to: Notification of Admission of hospitalizations, faxes, online payer databases, voicemail coverage, discharge notifications, determinations, etc in the UM department following established standards and practices, adhering to UM policies and standards. This position is fully on-site.

Requirements

Bachelor’s Degree
3 years Billing, health insurance, physician practice, case management, healthcare-related field, or equivalent operations.
Ability to complete data entry, communicate clearly & accurately both in written and verbal communication.
Knowledge of electronic medical records (EMR) and medical terminology.
Ability to interact effectively & professionally with all key stakeholders, members of the interdisciplinary team and with all Colleagues, as well as with all patients/families/representatives.
Ability to take direction, offer useful insight into work processes & brainstorm when challenges arise.
Strong ability to work collaboratively.
Strong organizational skills.
Demonstration of strong critical thinking and clear communication skill set, as well as ability to demonstrate flexibility, teamwork as well as a high level of autonomy.
Demonstration of ability to multi-task, prioritize/reprioritize as the day's work changes, as well as to assist others when work tasks are completed, involve leadership when challenging situations arise, and conduct oneself in a professional manner at all times through all interactions.

Nice To Haves

Bilingual in English and Spanish.

Responsibilities

Provides compliant, accurate and timely delivery of appropriate Observation Notification directly to patients/families/representatives while hospitalized under Observation Status/Patient Class.
Delivers other payer-based forms as warranted.
Documents all related information according to departmental policy and procedure.
Prioritizes coverage at largest hospital site.
Ensures smooth utilization management department functioning which includes answering phones, communicating effectively and professionally through emails, relaying messages, printing documents from various electronic applications, and running daily reports.
Accurately processes and documents incoming and outgoing communication in all forms in the hospital EMR or payer-specific web-based systems.
Communicates time-sensitive information to UM teammates.
Escalates challenges to leadership as needed.
Involves payer-based supervisory staff when warranted.
Communicates and documents all conversations with internal and external key stakeholders according to departmental policy and procedure.