Utilization Management Specialist

Duration: months contract (with possible extension)

Under the direction of the Manager of UM Operations, the Utilization Management Specialist triages all short stay inpatient admission requests to the appropriate inpatient review nurse and performs data entry into the CaseTrakker, eCare, Jiva and MedHOK systems. The UM Specialist also monitors and resolves pended events. For hospital occurrences, the UM Specialist will data enter the information from the hospital or extended care facility into CaseTrakker, eCare, and/or MedHOK. The UM Specialist is responsible for verbally communicating to the requesting facility of the inpatient notification number. The UM Specialist may be responsible for working reports, daily logs and the end of month reconciliation process as assigned for the delegated provider units.


Key Responsibilities/Essential Functions:

• Receive information by telephone or fax from physicians and hospitals regarding inpatient admissions
• Obtain required information from caller and perform data entry into the system according to department documentation standards following department’s guidelines.
• Generate and process daily designated reports, letters, delegated discharge logs and workload.
• Process Out of Network Forms and update events as necessary.
• Monitor generated reports to ensure timely turn around and decisions.
• Coordinate with Care Management to ensure that the inpatient admission is immediately conveyed in order to update the admission record in a timely manner.
• Works closely with the Clinician staff to coordinate the month end reconciliation process and day to day resolution of pended cases.
• Participates in department projects and special assignments for cross-coverage purposes to meet strict daily processing deadlines.
• Assists with the documentation of workflows and procedures and cross-trains co-workers as needed.
• Attends scheduled meetings, training sessions in both classroom and computer-based required training sessions.
• Maintains a current procedure manual as changes occur.
• Performs additional related duties as assigned by UM Ops Management.

Qualifications:

• - of Utilization Management or Care Management experience in a managed care setting.

Education:

• Associate’s degree or equivalent experience

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.