Manager-Utilization Review and Insurance Verification Palos Community Hospital
Manager-Utilization Review and Insurance Verification Palos Community Hospital
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
The Manager Utilization Review and Insurance Verification position reflects the mission vision and values of Northwestern Medicine adheres to the organizations Code of Ethics and Corporate Compliance Program and complies with all relevant policies procedures guidelines and all other regulatory and accreditation standards.
This position will manage and oversee daily operations of insurance verification & utilization and review nurses through effective use of systems staff management and reporting.
Responsibilities:
- Responsible for all verification activities including precertification and authorization.
- Coordination of services to facilitate the achievement of cost and quality patient care and appropriate use of resources.
- Meets on a regular basis with staff and other office personnel.
- Coordinates and supervises distribution of daily utilization and review nurse duties.
- Provides adequate staffing and scheduling for employees. Works understaffed shifts as needed.
- Assures that the insurance verification of all applicable accounts is maintained at approximately 5 days prior to date of service.
- Handles routine personnel issues in a timely manner including hiring recommendations and verbal and written counseling statements.
- Identifies and reports data system problems affecting insurance verification: assists DIS in rectifying any issues.
- Evaluates the work performance of all insurance verification staff providing training and education as necessary.
- Communicates all changes regarding insurance verification procedures to all appropriate staff both within and outside the business office.
- Keeps up to date with regulations legislation and all managed care contracts that effect utilization and review activities and verification and reimbursement procedures.
Preferred:
- Previous knowledge of managed care contracting
- Registered Nurse strongly preferred
Qualifications :
Requirements:
- Bachelors Degree and/or 5 years of supervisory experience in the hospital setting
- Minimum of 5 years experience working in hospital business office
- Problem resolution while maintaining good public relations.
- Experience in dealing with difficult situations.
- Excellent communication skills
Additional Information :
Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age sex race color religion national origin gender identity veteran status disability sexual orientation or any other protected status.
Remote Work :
No
Employment Type :
Fulltime
Employment Type
Full-time
