Clinic Utilization Review Specialist Job at Sidney Regional Medical Center, Sidney, NE

TitKSWlQYml3UGxMY0V2UWpZODgrVVJJaHc9PQ==
  • Sidney Regional Medical Center
  • Sidney, NE

Job Description

Sidney Regional Medical Center is searching for a Clinic Utilization Review Specialist to join our team. This is a full-time position supporting Sidney Regional Medical Center and patients. The position will be based at SRMC Pole Creek Crossing campus from 0800 to 1700 Monday-Friday.

Duties & Responsibilities:

  • Provides excellent customer service to internal and external SRMC customers.
  • Ensures that prior authorization requests are completed in a timely fashion to meet contractual requirements and ensures that all reviews are conducted using nationally recognized and evidence-based standards.
  • Analyze insurance, governmental, and accrediting agency standards to determine criteria concerning medical justifications and treatment or procedures.
  • Knowledgeable of criteria for Medicare, Medicaid, and private insurance coverage.
  • Efficiently navigate insurance provider portals.
  • Collaborate with nurses, physicians and ancillary staff to ensure all information/documentation is obtained to support authorization, level of care and/or medical appropriateness.
  • Acts as a resource to other departments, leveraging expertise relative to the authorization and medical necessity process.
  • Respond to common inquiries or complaints from patients or regulatory agencies and address them forward them to the appropriate person when necessary.
  • Is proficient in retrieving patient data in Electronic Medical Record.
  • Performs and maintains accurate documentation.
  • Communicates effectively with medical providers, nursing staff, rehab team and social workers so the needs of the patients can be met.
  • Assist director with identifying and completing process improvements for the facility that involves authorization activity.
  • Perform non-clinical Case Manager duties in Acute Care when needed.
  • Assist director when appropriate, in research to reduce denials and improve reimbursement.
  • Employee is expected to be sufficiently knowledgeable about the legal aspects of his or her responsibilities and activities to be able to avoid inadvertent violation of State and Federal statutes and regulations & standards and refrain from knowingly participating in illegal activities or failing to meet affirmative legal duties. Employee shall report any suspected or known illegal activity
  • Regular Attendance.
  • Other duties as assigned by management.

Education, Experience, & Licensure

  • Education: High school diploma or GED
  • Experience: Clerical/medical and prior authorization experience is preferred.

Knowledge, Skills, & Abilities:

  • Reliable and timely attendance
  • Strong customer service skills, both in-person and over the phone
  • Ability to multi-task and prioritize workload
  • Strong team player
  • Ability to keep information confidential and protect patient information

Sidney Regional Medical Center is an EEO Employer/Vet/Disabled

Job Tags

Full time, Monday to Friday,

Similar Jobs

Guangzhou Huajing machine Manufacture Co.,Ltd

Russian translation(俄语翻译) Job at Guangzhou Huajing machine Manufacture Co.,Ltd

/Qualifications/Requirements1/2CATTI/3Trados/MemoQAutoCAD43EPCQualifications/QualificationsRequest/Requirements1. Education background: Bachelor...

Interim HealthCare of the Black Hills

Hospice Chaplain/Spiritual Leader Job at Interim HealthCare of the Black Hills

Are you seeking a Chaplain/Spiritual Leader opportunity where you can make a real impact? Interim HealthCare Hospice is hiring for a Part-time Hospice Chaplain/Spiritual Leader. In this role, you will be the face of courage and spiritual savior to support patients and... 

CGI Group, Inc.

Senior system administrator Job at CGI Group, Inc.

 ...Position Description: We are looking for a Senior Systems Administrator to join our CGI team in Salt Lake City, UT. The successful candidate will work on mission-critical manufacturing systems as well as the large-scale enterprise server infrastructure supporting... 

Matthews Bus Alliance, Inc

Bus A/C Systems Technician (Level 2) Job at Matthews Bus Alliance, Inc

About UsRifled Air Conditioning is a premier provider in the bus air conditioning industry, specializing in the manufacturing,...  ...repair existing bus A/C systems* Diagnose and fix electrical and mechanical issues related to the A/C systems* Keep accurate records of... 

Asheville Chevrolet

Automotive Parts Manager Job at Asheville Chevrolet

Automotive General Motors Parts Manager - Asheville ChevroletFull Job DescriptionThe Parts Manager is responsible for running a profitable and efficient parts department. The Parts Manager will accomplish objectives through the use of proper purchasing procedures,...