Utilization Management Assistant

As a Utilization Management Assistant you will receive, process, facilitate and document all payer communications. This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third party payers. The Utilization Management Assistant supports the Utilization Management Hub department by recognizing trends and opportunities for process improvement and reporting those to leadership. The Utilization Management Assistant performs these duties with a high degree of accuracy utilizing critical thinking skills and in compliance with hospital policies, standards of practice and Federal and State Regulations.

• Receives, sends and documents payer requests for clinical documentation.
• Receives and documents payer authorization and communications including but not limited to concurrent denials.
• Coordination of peer to peer conversations, as applicable.
• Reviews surgery schedule to verify correct authorization is documented, if applicable.
• Identifies accounts lacking authorization and follows up with payers, as needed.
• Communicates with interdepartmental staff regarding payer documentation requests.
• Under RN direction submits requests for and follows up on administrative days authorization, where indicated.
• Identifies and reports trends to department Leadership.
• Utilizes payer related reports from Care Management software, where applicable.
• Collaborates with and supports the UM team including but not limited to UR and Denials RN.
• Contributes to the identification of opportunities for process improvement.
• Supports administrative departmental functions, as assigned.

• Minimum one year experience in a hospital, physician’s office, or medical group performing duties related to admitting, business office, payer communications or managed care or an equivalent combination of education and experience
• High school diploma or GED

• medical
• prescription drug
• dental
• vision plans
• life insurance
• paid time off
• tuition reimbursement
• 401(k)
• 403(b)

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings. Our Mission As CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. To learn more about a calling that defines and unites, please click here for more information about our mission, vision, and values.