Utilization Management Specialist-Msh-Case Management-Full Time-Days

Utilization Management Specialist- Case Management- MSH Full Time Job Req 2826222

Strength Through Diversity

Ground breaking science. Advancing medicine. Healing made personal.

Roles & Responsibilities:

JOB SUMMARY:

This position is responsible for coordinating requests for clinical information from Third Party Payors and providing support to a broad client base, both internal and external to the Institution. The position also facilitates and tracks concurrent adverse determinations and collaborates with other disciplines regarding patient care management.

• Receives and appropriately enters requests for reviews into case management information systems.

• Enters certification and denial data into case management information systems based on review of payor End of Day Reports, notification from internal and external Case Managers, financial screening, and other personnel within required time frame.

• Generates and distributes Payor Census Logs to external and on-site Case Managers.

• Assist with denial management and Discharge Appeals process.

• Contacts third party payers to assist case managers in obtaining authorization for Discharge Planning.

• Responsible for incoming communications via email, mail, phone or fax; monitors office voice mails.

• Prioritizes incoming communications and relays messages to Case Managers or other UM staff.

• Processes incoming packages.

• Provides patient-specific information to payors as needed.

• Screens and registers outside agency personnel in compliance with HIPAA regulations.

• Performs other daily tasks associated with case management information systems.

• Maintains office files, equipment, and supplies.

• Assist with scheduling appointments for assigned patients.

• Performs other duties as assigned.

Requirements:

Associate degree required; Bachelor's degree with coursework in business preferred.

Familiarity with Third Party Payor requirements preferred.

Strength Through Diversity

The Mount Sinai Health System believes that diversity and inclusion is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we're as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education and advancement as we revolutionize healthcare delivery together.

We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care.

Explore more about this opportunity and how you can help us write a new chapter in our story!

Who We Are

Over 38,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.

Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai Morningside (Formerly St Luke's), and New York Eye and Ear Infirmary of Mount Sinai.

The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression.

EOE Minorities/Women/Disabled/Veterans

Compensation

The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $46,349.95 - $66,950.11 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.