WellSpan Health Utilization Management Specialist- Mt Gretna, PRN as needed in Mt Gretna, Pennsylvania
Utilization Management Specialist- Mt Gretna, PRN as needed
Under direct supervision, performs a variety of duties related to pre-certification requirements for Medicare, Medical Assistance and third party payers. Assists with data collection, analysis and reporting.
Duties and Responsibilities:
The following are essential job accountabilities:
1 Reviews assigned cases for preauthorization and coordinates authorization and certification. 2 Performs concurrent review of cases to obtain continued stay authorization. 3 Works closely with and prepares information for outside review agencies. 4 Collects, reviews and retrieves data from records and reports for quality assessment, audit, study and research purposes. 5 Supports the Utilization Management Nurse with case research and analysis. 6 Works with medical and professional staff on a case-by-case basis to obtain appropriate clinical documentation for review as well as coding activities and DRG assignments.
WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multi-specialty medical group of more than 850 physicians and advanced practice clinicians, a home care organization, six respected hospitals, more than 15,000 employees, and 160 patient care locations. The region's only accredited Level 1 Trauma Center and Primary Stroke Center with an endovascular neurosurgery program. WellSpan is consistently recognized by IMS Health as one of the Top 100 Integrated Health Networks in the United States and has been recognized by Health Imaging and IT as one of the nation's "Top 25 Connected Healthcare Facilities." IMS Health is the leading provider of information services and technology for the healthcare industry.
WellSpan Health facilities are located in multiple counties across south central Pennsylvania and northern Maryland, all offering an ideal living environment to match the quality of work-life balance you’re seeking. The area offers abundant outdoor and cultural activities, including restaurants, theatre, golf courses, hiking trails, water sports and historic tours. Additionally, our communities are a short drive from several, large metropolitan areas including the Baltimore/DC metro area and Philadelphia.
If you value a strong sense of community, the more palatable pace of rural living, and the convenience of a workplace close to home, you’ll realize the advantages of considering WellSpan Health as part of your future.
Interpersonal skills necessary to work with both professional and support staff in a cooperative, diplomatic, and decisive manner.
Must be able to take charge of the review process in terms of the acquisition of the clinical information and in terms of the ability to assert the adequacy of the medical necessity criteria and the treatment plan.
Clinical, analytical skills necessary for the gathering, compiling, consolidating, and relaying of appropriate information from the patient medical record for the purpose obtaining funding and monitoring appropriateness and quality of care.
Mobility is required to go to the patient care units to review charts and compile information.
Verbal skills and listening ability are required to use the telephone for extended periods of time.
Advanced skill and ability in the use of computer technology for documentation purposes.
Visual ability required to review charts and other written materials.
Knowledge of the Diagnostic and Statistical Manual, patient care & and appropriate treatment modalities, levels of care, admission criteria, medical necessity criteria, medications & their uses, and health care delivery systems. Understands the requirements of the varied Managed Behavioral Health Organizations and the nuances of the review process and provider network for each. This level of knowledge is usually acquired through the completion of an RN or LPN degree, and at least two years of direct patient care experience in a mental health setting. A background in managed care is necessary.
Mt Gretna, Pennsylvania, United States
Additional Scheduling Info
Weekdays, daytime hours. A minimum of two shifts per month with the option to pick up additional available shifts.