Utilization Management Support Analyst-Per Diem

Montefiore Mount Vernon•St. Charles, IL

2d•$34•Onsite

About The Position

The UM Central Support Analyst manages the processes that are associated with ensuring health plan reimbursement for hospitalization. The Analysts serves as the principal Hospital contact with health plans for utilization management issues. He/she exhibits expertise in the knowledge of and ensures compliance with all regulatory and managed care organization requirements. He/she also interfaces with the Care Management Coordinators, Social Work staff, Care Management Resource Unit staff and other related Hospital associates in order to obtain the necessary information for ongoing authorization of inpatient stays and to facilitate the exchange of information from/to health plans to support discharge planning. The Analyst analyzes and documents all information regarding ongoing authorizations or denials of inpatient hospital services. He/she reports trends and provides recommendations to clinical management and hospital contracting staff when appropriate.

Requirements

Bachelors degree in business administration, health care or related field required
3 years as an associate in hospital utilization management or as an analyst in a managed care setting preferred
Knowledge of Medical Terminology and regulatory requirements of managed care organizations, Medicare and Medicaid preferred
Hands on experience in the use of computer software, spreadsheets, faxing, copy machines, etc.
Proficiency with Windows based software applications and data entry functions
Excellent interpersonal/communication/organizational skills
Commitment to interdisciplinary teamwork

Nice To Haves

3 years as an associate in hospital utilization management or as an analyst in a managed care setting preferred
Knowledge of Medical Terminology and regulatory requirements of managed care organizations, Medicare and Medicaid preferred