Utilization Review Assistant

Renown Health•Reno, NV

21h

About The Position

The Utilization Review Assistant provides clerical and support services to Utilization Review RNs and Utilization Management Coordinators at Renown Health. Under department leadership, the role supports communication and collaboration with insurance payors, Internal Physician Advisors, community providers, and Renown staff to coordinate authorization of patient stays. The position requires critical thinking, collaboration, communication, and the ability to prioritize and assess situations while maintaining quality services under stressful conditions. It does not provide patient care. The assistant helps ensure authorization notices are entered in electronic medical records, provider orders and patient status are appropriately updated before elective admissions, and peer-to-peer discussions between providers are coordinated for denials management. The role also supports timely submission of clinical documentation to payors, manages multiple fax lines, monitors reports and insurance portals for authorization notifications, and works with community providers to ensure appropriate orders are reflected on surgical accounts before the day of surgery. The position documents chart and phone reviews, identifies and communicates potentially avoidable or non-reimbursed days and quality indicators such as readmissions, and maintains role-related knowledge and competencies. Practice is aligned with the mission, vision, and goals of the Integrated Health System. The assistant must respect patients’ beliefs and values and advocate for their right to self-determination and informed choices.

Requirements

Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively.
Proficiency with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and Word.
Ability to use a computer for online learning, access online forms and policies, complete benefits enrollment, and access Epic and other supporting applications.
Ability to prioritize and assess situations while maintaining quality services under stressful conditions.
Must respect patient beliefs and values and advocate for patients’ right to self-determination and informed choices.

Nice To Haves

Understanding of medical terminology.
One year of clerical experience in the medical field.

Responsibilities

Support Utilization Review RNs and Utilization Management Coordinators with clerical and coordination services.
Communicate and collaborate with insurance payors, Internal Physician Advisors, community providers, and Renown staff to coordinate authorization of patient stays.
Ensure authorization notices are placed in electronic medical records.
Verify provider orders and patient status are updated appropriately and accurately before admission for elective surgeries.
Coordinate peer-to-peer discussions between providers for denials management.
Support timely submission of clinical documentation to insurance payors via fax.
Manage multiple fax lines and monitor reports and insurance portals for authorization notifications.
Collaborate with community providers to ensure appropriate orders are reflected on surgical accounts before the day of surgery.
Document chart and phone reviews and identify and communicate potentially avoidable or non-reimbursed days and quality indicators, such as readmissions.
Maintain knowledge and competencies related to role expectations.
Prioritize and assess situations while maintaining quality services under stressful conditions.
Respect patients’ beliefs and values and advocate for their right to self-determination and informed choices.