Compensation range:

Your rate of pay will be based on applicable experience

Enloe Health is a Level II Trauma Center located in beautiful Northern California. We offer a full array of medical services and our mission is to elevate the health of the communities we serve. As a Planetree organization we place high value on hiring the right team to care for our patients and their familiescare that is steeped in compassion human connection and mutual support. If you feel called to make a meaningful impact through empathetic person-centered care and thrive in a culture that values collaboration and purpose we welcome you to join our team.

POSITION SUMMARY:

The Utilization Management Specialist (UMS) functions as a member of the Utilization Management Department (UM) assigned to support Utilization Review Denials Management Regulatory Clinical Documentation Integrity and Transfer Coordination. The Specialist also collaborates with Patient Financial Services HIM Case Management Quality and other departments as needed. Essential tasks include processing and or troubleshooting inpatient admission authorization CCS referrals compiling and sending appeals interfacing with payors on denials and appeal determinations troubleshooting intricate and complicated payor issues forwarded from other departments scheduling peer to peer discussions maintaining essential tracking spreadsheets. UMS also provides administrative assistant support to UM including main department phone line payor requests sick calls tracking employee employment requirements assisting with onboarding as assigned attending assigned meetings supply ordering and record keeping. The UMS creates a cooperative impression throughout all interactions with internal and external customers and works independently to prioritize and manage multiple priorities. The UMS contributes to the service excellence mission of Enloe Medical Center and the Utilization Management Department. The UMS is responsible for establishing and maintaining an orderly work environment that supports the smooth operation of the department. They perform other duties as assigned.

EDUCATION / TRAINING / EXPERIENCE:

Minimum:

• Two years experience working with computers (including databases spreadsheet Microsoft Office) OR an Associate degree or higher in a human service or other health related field OR two years experience in a medical setting.

Desired:

• Previous experience in a case or utilization management setting
• Previous experience in medical back office including insurance and billing

SKILLS / KNOWLEDGE / ABILITIES:

Working knowledge of medical terminology. Proficient in the use of Microsoft Word Excel and Internet access and use. Skilled in the collection and analysis of data and assessment of data integrity. Ability to learn state and federal funding sources. Analytical and grammatical skills are necessary to communicate effectively verbally and in writing. Demonstrates evidence of strong skills in confidentiality integrity creativity and initiative. Demonstrates ability to interact with a wide variety of individuals and handle confidential/sensitive situations and information with tact and sensitivity. Must be able to maintain strict confidentiality always. Must be self-motivated flexible and detail oriented. Must be able to fulfill the essential functions of the position.

Benefits Information

Enloe offers a comprehensive and competitive benefits package to all eligible employees including but not limited to:

• $0 premium medical plan to include vision insurance
• Prescription and dental group insurance
• Retirement with employer match
• Generous paid time off (PTO) plan that starts accruing immediately and can be used as its earned
• Extended Sick Leave
• Flexible Spending Accounts for unreimbursed medical expenses and dependent care
• Employee Assistance Program
• Educational Assistance

Please visit the employee benefits page at get more in-depth benefits and coverage information or email to receive a full summary of benefits.