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- Maintain strictest confidence of all patients protected health information (PHI) and protects all PHI from accidental, intentional, or inappropriate disclosure.
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Utilization Review Specialist - Berkeley, United States - Sutter Health
Description
Organization:
ABSMC-Alta Bates Herrick Campus
Position Overview:
Accumulates, interprets, and documents timely information to justify acute hospital admission, need for continued stay, and proper utilization of physician, nursing, and ancillary services.
Develops, coordinates and monitors systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area.
Collaborates with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of services and appropriate service reimbursement.
Monitors and acts as a liaison between external payers, internal business office, admissions staff, and clerical unit staff to assure that quality care is delivered at the appropriate level of service and that documentation of care meets appropriate standards.
Interfaces with hospital administration and unit medical doctors and provides data related to the current management of resources. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety while delivering optimal patient care.Job Description:
These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job.
Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).
JOB ACCOUNTABILITIES:
CASE MANAGEMENT:
CLERICAL:
SAFETY:
COMPLIANCE:
EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma
Bachelor's:
Business Administration or related field
DEPARTMENT REQUIRED EDUCATION
Equivalent experience will be accepted in lieu of the required degree or diploma
Department, Behavioral Health:
Master's in Social Work or related field
SKILLS AND KNOWLEDGE:
Working knowledge of medical terminology, including general knowledge of illnesses, current treatments and their physical and psychosocial sequelae.
Knowledge of alternate levels of care including criteria required for payment and applications processes.
Ability to interpret a variety of data and instructions, furnished in written, oral, diagram, or schedule form.
Possess written and verbal communications skills to communicate with fellow team members, supervisors, patients, and other hospital personnel.
Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized policies and procedures to achieve objectives and meet deadlines.
Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions.
Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options.
Ensure the privacy of each patient's protected health information (PHI).
Build collaborates relationships with peers and other staff members to achieve departmental and corporate objectives.
PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
Occasionally
Benefits:
Yes
Unions:
No
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $40.85 to $61.28 / hour
The salary range for this role may vary above or below the posted range as determined by location.
This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled.
Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs.
Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.
