Utilization Management Assistant

Utilization Management Assistant

The Utilization Management Assistant supports the coordination and execution of utilization review processes to ensure that healthcare services are used efficiently and appropriately. This role involves administrative support, data tracking, and communication with providers, patients, and insurance companies.

Essential Job Statements

Authorization Support: Assist in obtaining authorization and continued stay authorizations from insurance companies.

Data Management: Track and distribute fax communication and upload documents from insurance portals into HER.

Communication: Serve as a liaison between providers, patients, payers, and internal departments to facilitate utilization management services.

Documentation: Maintain accurate records of authorization, denials, appeals, and other UM activities as needed.

Policy Adherence: Follow UM policies and procedures, escalating issues when necessary.

Customer Service: Complete administrative duties which may include fax distribution, answer telephone inquiries, and forwarding to the appropriate team members.

Miscellaneous: Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and department. Provides assistance to team members. Accepts alternate assignments as required.

Employment Qualifications

Required Education: High School Diploma or equivalent

Preferred Education: Some college level education

Licensing/Certification Required: N/A

Licensing/Certification Preferred: N/A

Minimum Qualifications

Years and Type of Required Experience: One (1) year of experience in an acute care academic medical center or comparable organization

Other Knowledge, Skills and Abilities Required: Knowledge of computers and various computer programs such as Microsoft Suite products [Word, Excel, and Adobe Professional]

Other Knowledge, Skills and Abilities Preferred: Effective communication skills, both verbal and written. Strong organization skills, follow-through abilities, and time management skills. Solid problem solving and decision-making skills. Demonstrated flexibility and assertiveness. Skills in establishing and maintaining cooperative and "team" oriented working relationships with others.

Working Conditions: Periods of high stress and fluctuating workloads may occur. May have periods of constant interruptions. Prolonged periods of working alone.

Physical Requirements:

Physical Demands: N/A

Work Position: Sitting

Additional Physical Requirements/Hazards:

Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Repetitive arm/hand movements, Finger Dexterity

Hazards: N/A

Mental/Sensory Emotional:

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking

Emotional: Fast paced environment, Steady Pace, Able to Handle Multiple Priorities, Able to Adapt to Frequent Change