IntakeUtilization Mgmt Specialist Full time Days

Monday- Friday.

The Intake Specialist Home Infusion Pharmacy reflects the mission vision and values of NM 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 role serves as the point-of-entry for the Home Infusion Pharmacy department.

Responsibilities:

• Engages in front-end utilization management and per-protocol onboarding procedures to ensure a safe efficient and accurate intake process for the pharmacy.
• Actively and effectively serves as a remotely functioning liaison for the home infusion pharmacy to case managers social workers physicians and other referring partners.
• Monitor and respond to requests for Home Infusion Pharmacy services in an efficient accurate and professional manner via several platforms such as email phone and Allscripts/Careport to name a few.
• Exercise autonomy when scrutinizing prospective referrals for acceptance. Navigate and leverage tools to make informed decisions about referral acceptance and denial. Maintain and update reference tools as appropriate.
• Conduct eligibility verification benefits investigation test claims (when applicable) and prior authorizations for all cases related to Home Infusion Pharmacy. Assist in the coordination of appeals for prior authorization denials when indicated. Must have ability to navigate and execute functions within health insurance electronic portals and/or communicate with payor representatives via telephone.
• Actively communicate with members of the care management team patient care team and pharmacy to provide status updates on referrals. Communication mode (email phone progress note warm hand-off etc.) may vary depending on the audience and situation.
• Work with Pharmacy software (CPR) to create patient profiles and document communication notes in order to keep the Pharmacy team abreast of new information.
• Provide accurate information and timely updates to patients and customers. Addresses questions and concerns promptly or identifies appropriate person and resources to do so.
• Participates in efforts to reduce costs streamline work processes improve and grow services provided.
• Utilizes department and hospital policies and procedures to complete assigned tasks.
• Demonstrates knowledge and compliance with insurance local state and federal regulations related to physician and hospital billing. Has a firm understanding of those home infusion services covered by commercial and federal payers.
• Participate in team meetings quality improvement initiatives and other activities as requested.
• Assist with the onboarding and training of new members of the team.
• Other responsibilities as assigned and indicated

Qualifications :

Required:

• High School Diploma
• Two (2) years progressive work experience in any one of the following: hospital/physician utilization management. Also acceptable: retail pharmacy/PBM/Home Infusion as a billing representative UM professional patient services representative and/or pharmacy technician.
• Knowledge of EPIC systems Microsoft applications referral platforms such as Allscripts/Careport and CPR. If has not engaged in these applications must have the ability to quickly learn.
• Ability to manage multiple priorities in a fast-paced environment.
• Exceptional organizational skills and detail orientation which includes ability to prioritize tasks and keep records so they remain readily retrievable.
• Excellent customer service and communication skills
• Experience that has contributed to the understanding of insurance rules and regulations especially Medicare and Medicaid.

Preferred:

• 2 years college or college degree
• Five (5) years progressive work experience in any one of the following: hospital/physician utilization management. Also acceptable: retail pharmacy/PBM/Home Infusion as a billing representative UM professional patient services representative and/or pharmacy technician.
• Call center telephone work experience
• High-level problem solving analytical and investigational skills

Additional Information :

Northwestern Medicine is an equal opportunity employer (disability VETS) 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.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and at times internal transfers. If you are offered a position with us you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis and we follow all local state and federal laws including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position however all employment decisions will be made by a person. 

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical emotional and financial well-being while providing protection for unexpected life events.

Click on or copy and paste URL to your browser to view detailed benefits information   

NorthwesternMedicine Career Page

refer to the Benefits Eligibility by Employment Classification to determine benefits eligibility for job postings. 

If sign-on bonus is included in a job posting eligibility is as followed: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign-on bonus. Exception: New graduate internal employees seeking their first licensed clinical position as a Registered Nurse at NM may be eligible.

Remote Work :

No

Employment Type :

Full-time