Utilization Review Assistant
: Job Details :

PURPOSE STATEMENT: Provide administrative support to the Utilization department. ESSENTIAL FUNCTIONS: Perform pre-certification and negotiate continued stay with third party payers in a professional manner. Gather data to support case management activities, including presentation of gathered data and case notes. Verbally present knowledge of cases and the needs of third-party payers in a timely manner. Assist in admissions review, concurrent reviews and discharge planning. Assist physician in peer review by serving as information resource, gather data to support review and schedule peer review. Keep leadership advised of status of current patients, in regard to utilization activities through timely documentation and participate in performance improvement activities. Coordinate with clinical team for discharge planning, maintain CRM database with discharge information and follow up. OTHER FUNCTIONS: Perform other functions and tasks as assigned. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: High school diploma or equivalent required. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)