drjobs Util Mgmt Specialist I

Util Mgmt Specialist I

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1 Vacancy
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Job Location drjobs

Knoxville, TN - USA

Monthly Salary drjobs

Not Disclosed

drjobs

Salary Not Disclosed

Vacancy

1 Vacancy

Job Description

Overview

Utilization Management Specialist Revenue Integrity and Utilization

Full Time 80 Hours Per Pay Period Day Shift

Covenant Health Overview:

Covenant Health is the regions topperforming healthcare network with 10hospitalsoutpatient and specialtyservicesandCovenant Medical Group our areas fastestgrowing physician practice division. Headquartered in Knoxville Covenant Health is a communityowned integrated healthcare delivery system and the areas largest employer. Our more than 11000 employees volunteers and 1500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes Best Employer seven times.

Position Summary:

The Utilization Management Specialist I will perform utilization management functions to include medical necessity reviews to promote a utilization management program. The UM Specialist prepares and reviews necessary documentation for insurance utilization management processes and coordinates communication between members of the UM team to ensure timely follow through for status placement. The UM Specialist collaborates with attending physician if ambiguous documentation pertaining to patient status placement requires clarification. The UM Specialist utilizes electronic utilization management database for documentation of interventions and communications so as to ensure accurate reporting. Collaborates with patient account services physicians care coordinators physician advisors and facility departments as related to utilization management. Communicates with hospital and payor medical directors in order to correctly determine the medical necessity of patient status with a patient advocacy focus.

Recruiter: Kathleen Rice

Responsibilities

Qualifications


Required Experience:

Unclear Seniority

Employment Type

Full-Time

About Company

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