Corewell Health
healthcare
UtilizationMgmtSpec
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Utilization Mgmt Spec at Corewell Health. Skills: process management, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement, communication skills. Assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction.. Participates in activities with third party payors in order to maximize reimbursement.”
What You'll Achieve.
maximize reimbursement; ensure patient/customer satisfaction
Industry & Context.
Problem solves issues that are received via phone, fax or email.
MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.
What They're Looking For.
Must Have
High School Diploma or equivalent
Nice to Have
Post high school training and/or academic coursework leading toward associate’s or bachelor’s degree, 2 years of relevant experience healthcare experience
What You'll Do.
Assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction.
Participates in activities with third party payors in order to maximize reimbursement.
Understands and accesses insurance websites.
Completes required duties as defined for specific payers to obtain authorization numbers for payment.
Provides clerical support for Utilization sorting faxes and mail
obtaining authorization numbers
completing follow-up on outstanding cases
and delivery of letters associated with outpatient or inpatient status.
Utilizes electronic medical record work queues that support Utilization Management functions.
Answers incoming calls or places outbound calls with appropriate communication skills.
Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up.
Problem solves issues that are received via phone
How You'll Work.
Team & Collaboration
cross-functional coordination
Communication Scope
appropriate communication skills
Full Job Description
## Job Summary Under general direction, assists in the provision of the highest service level possible to patients/customers to ensure their satisfaction. Participates in activities with third party payors in order to maximize reimbursement. ## Essential Functions * Understands and accesses insurance websites. Completes required duties as defined for specific payers to obtain authorization numbers for payment. * Provides clerical support for Utilization Management; sorting faxes and mail, obtaining authorization numbers, completing follow-up on outstanding cases, and delivery of letters associated with outpatient or inpatient status. * Utilizes electronic medical record work queues that support Utilization Management functions. * Answers incoming calls or places outbound calls with appropriate communication skills. Triages all calls to the appropriate person for resolution and action or completes appropriate follow-up. * Problem solves issues that are received via phone, fax or email. * Other duties as assigned. ## Qualifications Required * Required High School Diploma or equivalent Preferred * Post high school training and/or academic coursework leading toward associate’s or bachelor’s degree. * 2 years of relevant experience healthcare experience. ## About Corewell Health As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence. ## How Corewell Health cares for you * Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more [here](https://careers.corewellhealth.org/us/en/benefits-new
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