York, PA | Professional | Tracking Code: 85664

Utilization Management Specialist

James Kane
James Kane
Sr. Talent Acquisition Consultant
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May 18 In-Person Hiring Events
10:00 a.m. – 2:00 p.m.
WellSpan Ephrata Community Hospital, Ephrata / WellSpan Surgery and Rehabilitation Hospital, York / WellSpan Waynesboro Hospital, Waynesboro
Positions: Certified Sterile Processing Technicians, Food Services, Housekeeping, LPN, Medical Assistant, Nursing, Nursing Support, Pharmacy, Allied Health: Lab Services, Respiratory, Imaging, Surgical Technologist, Home Health RN, Home Health LPN
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May 25 In-Person Hiring Events
10:00 a.m. – 2:00 p.m.
WellSpan Medical Group, York
Positions: Dental Assistant, Dental Hygienist, Medical Assistant, LPN, Patient Service Specialists
MAY
2022
In-Person Hiring Events -
Various Locations and Dates

Job Description:

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

 

  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
  7. review as well as coding activities and DRG assignments.

 

Qualifications

  • Notes:
    • Other combinations of formal education, training and experience may be considered.

 

  • Minimum Experience:
    • 2 - 3 years
    • Previous coding experience is a plus
    • Any prior authorization experience a plus
    • Any Oncology experience a plus

 

  • Minimum Education:
    • Associate's Degree

 

  • Minimum Field Of Expertise:
    • Utilization Management

 

  • Skills:
    • Basic computer skills

Fraud Notice: Please be aware of potentially fraudulent job postings on other websites or suspicious recruiting email or text messages that attempt to collect your confidential information. If you are concerned that an offer of employment with WellSpan Health might be a scam, please verify by searching for the job posting on joinwellspan.org or contact us at employment@wellspan.org.


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