Utilization Review Assistant

Trinity Health • Mason City, IA

5d

About The Position

The Utilization Review (UR) Assistant supports utilization management activities and serves as the central coordinator for postacute prior authorizations (PAs) for skilled nursing, swing bed, CAH swing, acute rehab, LTACH, and other postacute levels of care. This role drives timely authorization determinations, reduces authorizationrelated delays, supports throughput goals, decreases avoidable inpatient days, and helps ensure efficient discharge planning. Responsibilities include PA submission and followup, denialprevention support, external notifications, data extraction from the chart, Epic work queue tasks, supporting second IMM processes as needed, coordination with payers and postacute facilities, and administrative support for the acute population care management team.

Requirements

• Must be one of the following: Licensed Practical Nurse (LPN) with an active, unrestricted license, OR Certified Medical Assistant (CMA/CCMA/RMA) with active, current certification.
• Minimum of two (2) years of practice in the licensed/certified discipline (LPN or CMA) required.
• Minimum two years of direct LPN or CMA practice required.
• Basic Life Support (BLS) within 60 days of hire; must maintain certification.
• Mandatory Reporter – Child & Dependent Adult Abuse within 6 months of hire; renewal per policy.
• Strong organizational and time‑management skills; detail‑oriented.
• Proficient in email, internet navigation, payer portals, and Microsoft Excel and Word.
• Ability to multitask and work independently while collaborating with multidisciplinary teams.
• Strong customer‑service skills aligned with MercyOne mission and values.
• Upholds the Mission, Values, Standards of Conduct, and all organizational policies/procedures.
• HIPAA Security Level: High — access to restricted/confidential PHI; compliance with all security policies is required.

Nice To Haves

• Demonstrated experience in UR, discharge planning, or postacute workflows preferred.

Responsibilities

• Post‑Acute Prior Authorization Management (Primary Function) Centralizes, submits, monitors, and follows up on post‑acute prior authorizations using payer portals, phone calls, and clinical documentation workflows. Ensures complete and accurate clinical packets; escalates delays when authorization timelines exceed expectations. Documents all PA activity in Epic and maintains standardized PA workflows for consistency and efficiency. Communicates PA status and clinical needs to postacute facilities, payers, case managers, social workers, and UR RNs. Provides external notification of discharges and post‑acute transfers. Supports implementation and evaluation of the centralized PA workflow, including establishing a regular cadence for outcome monitoring.
• Utilization Management & Denial Prevention Support Extracts meaningful data from the medical record to support UR/Concurrent Review RN clinical reviews. Identifies potential concurrent denials and routes information to UR RNs promptly. Gathers documentation for denial reviews and assists with payer communication. Inputs payer authorization information into systems to support payment of services rendered. Reviews and monitors UR reports to identify necessary actions to reduce denials.
• Throughput Collaboration Acts as a liaison between internal departments, physicians, outside facilities, and hospital units to promote patient flow, discharge coordination, and receipt of medically appropriate care at the correct level.
• Patient & Payer Communications Meets with admitted patients to review Medicare notices (such as the Important Message from Medicare/IMM). Clarifies payer medical benefits, policies, and procedures to patients, physicians, office staff, contract providers, and facilities.

Benefits

• Education Assistance offered
• Effective Day 1 Benefit Package (Medical, Dental, Vision, and more) for positions 16 hours per week or greater
• Competitive wages; including weekend and night differentials
• Generous paid time off program
• Retirement Savings program with employer match starting on Day 1

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 251-500 employees