Utilization Review Specialist | Part Time

Concord Hospital Health System · Concord, NH · 2 wk ago

OTHRPart-time

Process all incoming electronic faxes from payers that include approvals, denials, and requests for clinical information.
Accurately interpret and disseminate faxes to the appropriate UR nurse, physician advisor, appeals nurse, etc.
Celebrates all peer-to-peer meetings with insurance payers.
Maintains schedule for Physician Advisors and communicates all meetings/activities with the Physician Advisor.
Affords assistance with appeals and denial clerical processes as directed.
Creates and maintains databases/dashboards, filing systems, documents and data for department specific processes and protocols.
Affords assistance with preparation and updating of utilization review related reports, presentation material, as required.
Participates in, and supports assigned department and hospital meetings, committees and functions.
Provides overall administrative support for UR clinical leader, UR team, and Physician Advisors.
Performs job specific competencies and other duties as assigned including providing back up coverage for care management administrative assistant.
Ensures compliance with relevant regulations and guidelines related utilization review, such as those with CMS, DNV and others.

Experience working in a hospital, insurance company, or medical office setting is preferred.
Demonstrated ability to effectively and positively interact with a multidisciplinary staff, patients and others.
Demonstrated ability to perform as a member of a team.
Knowledge of medical terminology and skills in multi-tasking, critical thinking and problem solving.
Proficient in Microsoft Office applications, Cerner.
Knowledge of revenue cycle is a plus.

Education Associate’s degree or equivalent in related field from two-year college or technical school.
Bachelor’s degree in related field a plus.

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