Utilization Management Resource Specialist (Per Diem)

Mass General Brigham•Somerville, MA

2d•$20 - $28•Remote

About The Position

Reporting to Manager for Utilization Management, the Utilization Management Resource Specialist (UMRS) works collaboratively with the Utilization Management Case Managers (UMCM), Clinical Operations, Revenue Cycle Operations, and the Physicians Advisors providing direct administrative support to the utilization review processes and to the department. The UMRS must have strong communication skills and the ability to converse comfortably with internal and external customers. The position requires a high degree of flexibility, independence and willingness to participate in multiple activities and provide support to all members of the MGB team. Work collaboratively with MGB Utilization Management to support an efficient, cost effective, and compliant utilization plan and care needs along the continuum. This may include, but is not limited to:

Requirements

High School Diploma or equivalent required.
2+ years of related healthcare experience preferred (medical terminology, EMR, hospital UM or CM, medical receptionist, prior authorization)
Familiarity with medical terminology.
Familiarity with community services/resources.
Ability to maintain effective working relationships with patients/families.
Knowledge of current community resources.
Strong assessment and crisis intervention.
Strong collaborative skills and a desire to work in a complex, fast-paced environment.
Excellent interpersonal skills.
Excellent collaboration, customer service, and advocacy skills.
Excellent written and verbal communication skills.

Nice To Haves

Associate's Degree preferred.

Responsibilities

Provides direct support to the utilization management case managers
Provides reports to internal and external customers
Conducts daily data collection per direction of UM leadership.
Checks UR line for voicemails
Faxes/emails communications to internal and external customers
Manages email communication from payors by entering requests into the payor request folder, entering requests into the peer to peer folder, forwarding payor emails to appropriate CM staff.
Enters approved LOS from payors in EPIC
Enters denials in the retro folder and documents the denial in auth cert.
Works collaboratively with Admitting ensuring the patient has correct insurance entered and appropriate prior authorization.
Manages all incoming faxes/emails
Scans mail, memos, and other documents and enters approvals in EPIC
Assists in escalating payor authorizations for patients going to rehab
Updates payor dictionaries.