Job Information
University of Michigan Utilization Management Assistant in Ann Arbor, Michigan
Utilization Management Assistant
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Mission Statement
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Why Join Michigan Medicine?
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world’s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
What Benefits can you Look Forward to?
Excellent medical, dental and vision coverage effective on your very first day
2:1 Match on retirement savings
Responsibilities*
Essential:
Data entry of clinical review information for online authorizations into multiple web sites for multiple payers
Maintain accuracy of payer grid by notifying appropriate staff and Revenue Cycle of changes in fax numbers, etc.
Obtain authorization for services from third party payers and notify RN Case Manager of issues with authorizations
Enter authorization numbers and approval days/dates into the appropriate software system for utilization management and electronic medical records.
Fax clinical reviews to payers, maintain confirmations, document completely and accurately activities performed
Interact with payers during phone conversations, provide discharge dates and patient status information
Respond to email from Billing Department with requests for authorization numbers or patient status
Answer departmental phones/messages and distribute to RN Case Managers mindful of coverage assignments.
Assist in obtaining authorization for inpatient and observation care by providing payers with clinical information via fax, autoroute, and web-based programs, for example, E-Referral, Navinet, Pnote
Demonstrate ability to use multiple computer programs to research patient information
Willingly and consistently offer assistance to staff especially when patient census is high
Actively participate in learning new technologies
Provide notification to out of state insurers when requested by case managers
Other duties as assigned
DAILY WORK DUTIES
Insurance Alert Changes from software system for utilization management: notify RN CM if additional clinicals are required
For web-based programs, for example, P Notes for Blue Cross PPO and Traditional and E Referral for Blue Cross Network (BCN), input patient data, submit initial review with InterQual criteria subset (1511 work queue)
Utilize Accuroute a software fax program effectively
Authorizations/Certifications – obtained by phone calls, faxes, payer contact screen
Combining Admissions – documenting in MiChart, submit codes for billing
Telephone notification of out of state insurers, providing ICD codes (clinical follows)
Navinet – Online portal to start process for Aetna, Cigna, BC Complete, Amerihealth, Priority to obtain authorizations and check for updates
General faxing
DCPA – authorizations pended, discharge information required
223 List in MiChart to complete input of auths/certs
Follow up on emails from professional billers by editing patient information in the utilization management software.
Distribution of cases on the unassigned worklist
Required Qualifications*
High School Diploma or GED.
An Associate's degree in social sciences or other related field or an equivalent combination of education and experience is necessary
2 -3 years of experience.
Analytical skills are necessary in order to assess urgency and complexity of workflow
Proficiency in medical terminology
Proficiency in use of computer technology and experience with Microsoft Office software applications
Strong interpersonal communication skills, including problem solving and decision making
Demonstrated telephone communication skills required
Experience in a health care environment
Ability to work well with physicians and other health care providers
Strong customer service and ability to work in a team environment
Desired Qualifications*
Knowledge of UR processes and different levels of care within a hospital
Knowledge of the University of Michigan Hospitals and Health Systems computer software systems
Knowledge of the University of Michigan Hospitals and Health Systems Policies and Procedures
Work Schedule
Work schedule varies. Monday through Friday with some weekend and holiday coverage. Hours are 9:00am to 5:30pm
Modes of Work
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about thework modes (https://hr.umich.edu/working-u-m/my-employment/ways-we-work-resource-center/ways-we-work-implementation-group/modes-work) .
Union Affiliation
This position is included in the bargaining unit represented by the Service Employees International Union - Healthcare Michigan (SEIU), which represents bargaining unit members in all matters with respect to wages, benefits, hours, and other terms and conditions of employment.
Background Screening
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Application Deadline
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.
Job Detail
Job Opening ID
256148
Working Title
Utilization Management Assistant
Job Title
Patient Services Intermediate
Work Location
Michigan Medicine - Ann Arbor
Ann Arbor, MI
Modes of Work
Mobile/Remote
Full/Part Time
Full-Time
Regular/Temporary
Regular
FLSA Status
Nonexempt
Organizational Group
Um Hospital
Department
MM OH Care Mgt
Posting Begin/End Date
1/03/2025 - 1/17/2025
Career Interest
Healthcare Admin & Support
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