Utilization Mgt Authz - Providence, United States - Rhode Island Hospital

Rhode Island Hospital

Verified Company

Providence, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

Summary:

Under the supervision of a Utilization Management Manager and in collaboration with the care team assists patients and families locating and coordinating appropriate personal hospital community and financial resources within a specialty service area.

Responsibilities:

Consistently applies the corporate values of respect honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly geographically accessible and high-value services within the environment of a comprehensive integrated academic health system.

Is responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct...

Provides patient and family information to appropriate hospital personnel and community agencies in order to assist in resolving identified issues utilizing HIPAA principles.

Maintains appropriate documentation and statistics regarding case activity.

May participate in departmental studies and projects to include planning and coordinating activities.

Maintains list of hospital and community services and resources.

Maintains and enhances professional expertise through appropriate educational activities as necessary.

Arranges and coordinates connective referrals to appropriate community agencies and programs.

Conducts activities related to Utilization Management including securing authorizations or concurrent reviews to ensure payment for hospitalization.

With the health care team planning and executing discharge plans including coordination of placement in a variety of settings.

Works closely with treating physician and utilization management leadership to address insurance denials and participates in denial process.

Other information:

BASIC KNOWLEDGE:

Bachelors Degree in Social Work or related field including but not limited to psychology humanities public health healthcare management

Demonstrated knowledge and skills necessary to provide care patients with consideration of aging processes human development stages and cultural patterns in each step of the care process.

EXPERIENCE:

One year professional experience working in health care setting or human service agency preferred.

Experience with managed care desirable.

Knowledge of health care and health care delivery systems.

Analytical skills necessary to evaluate patients concrete needs and to formulate and implement a treatment plan.

Interpersonal skills to effectively interact with patients families medical staff and outside agencies in providing services.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

Normal office environment with some exposure to patient care environments. May be some remote home-based work after successful probationary period

SUPERVISORY RESPONSIBILITY:

None

Location:
Rhode Island Hospital

USA:

RI:
Providence

Work Type:
Per Diem

Shift:
Shift 2

Union:
Non-Union