Employment Type:

Shift:

Description:

Full Time

Day Shift

40 hours weekly

Position Purpose:

The Utilization Review (UR) Assistant supports utilization management activities and serves as the central coordinator for postacute prior authorizations (PAs) for skilled nursing swing bed CAH swing acute rehab LTACH and other postacute levels of care.
This role drives timely authorization determinations reduces authorizationrelated delays supports throughput goals decreases avoidable inpatient days and helps ensure efficient discharge planning.
Responsibilities include PA submission and followup denialprevention support external notifications data extraction from the chart Epic work queue tasks supporting second IMM processes as needed coordination with payers and postacute facilities and administrative support for the acute population care management team.

What you will Do:

1) PostAcute Prior Authorization Management (Primary Function)

• Centralizes submits monitors and follows up on postacute prior authorizations using payer portals phone calls and clinical documentation workflows.

• Ensures complete and accurate clinical packets; escalates delays when authorization timelines exceed expectations.
• Documents all PA activity in Epic and maintains standardized PA workflows for consistency and efficiency.
• Communicates PA status and clinical needs to postacute facilities payers case managers social workers and UR RNs.
• Provides external notification of discharges and postacute transfers.
• Supports implementation and evaluation of the centralized PA workflow including establishing a regular cadence for outcome monitoring.

2) Utilization Management & Denial Prevention Support

• Extracts meaningful data from the medical record to support UR/Concurrent Review RN clinical reviews.
• Identifies potential concurrent denials and routes information to UR RNs promptly.
• Gathers documentation for denial reviews and assists with payer communication.
• Inputs payer authorization information into systems to support payment of services rendered.
• Reviews and monitors UR reports to identify necessary actions to reduce denials.

3) Throughput Collaboration

• Acts as a liaison between internal departments physicians outside facilities and hospital units to promote patient flow discharge coordination and receipt of medically appropriate care at the correct level.

4) Patient & Payer Communications

• Meets with admitted patients to review Medicare notices (such as the Important Message from Medicare/IMM).
• Clarifies payer medical benefits policies and procedures to patients physicians office staff contract providers and facilities.

Minimum Qualifications:

Education & Licensure

• Must be one of the following:
  • Licensed Practical Nurse (LPN) with an active unrestricted license OR
  • Certified Medical Assistant (CMA/CCMA/RMA) with active current certification.
• Minimum of two (2) years of practice in the licensed/certified discipline (LPN or CMA) required.

Experience

• Minimum two years of direct LPN or CMA practice required.
• Demonstrated experience in UR discharge planning or postacute workflows preferred.

Certifications

• Basic Life Support (BLS) within 60 days of hire; must maintain certification.
• Mandatory Reporter Child & Dependent Adult Abuse within 6 months of hire; renewal per policy.

Knowledge Skills & Abilities

• Strong organizational and timemanagement skills; detailoriented.
• Proficient in email internet navigation payer portals and Microsoft Excel and Word.
• Ability to multitask and work independently while collaborating with multidisciplinary teams.
• Strong customerservice skills aligned with MercyOne mission and values.

Corporate & Compliance Expectations

• Upholds the Mission Values Standards of Conduct and all organizational policies/procedures.
• HIPAA Security Level: High access to restricted/confidential PHI; compliance with all security policies is required.

Position Highlights and Benefits:

• Education Assistance offered

• Effective Day 1 Benefit Package(Medical Dental Vision and more)for positions 16 hours per week or greater

• Competitive wages; including weekend and night differentials

• Generous paid time off program

• Retirement Savings program with employer match starting on Day 1

Ministry/Facility Information:

MercyOne North Iowa Medical Center provides expert health care to 15 counties.

MercyOne North Iowa Medical Center is a 342 bed regional referral teaching hospital in Mason City Iowa. MercyOne New Hampton Medical Center is an 11 bed rural access hospital in New Hampton Iowa. Our service area spans 15 counties across northern Iowa and southern Minnesota. We serve a population over 260000.

With more than 3000 colleagues and a medical staff of almost 500 physicians and allied health professionals MercyOne North Iowa Medical Center is the largest employer in the region.

MercyOne Medical Group North Iowa is part of Iowas largest multispecialty clinic north Iowa our clinics are made up of more than 25 primary care pediatric internal medicine and specialty clinics.

Our Commitment

Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability veteran status or any other status protected by federal state or local law.