RN Utilization Management Specialist-Admissions (Remote) (Part-Time/Day Shift)
Company: Lancaster General Hospital
Posted on: January 22, 2023
SummaryThe RN Utilization Management Specialist - Admissions is
responsible for evaluating medical records to determine severity of
patient's illness and the appropriate patient class in accordance
with industry guidelines. Serves as a liaison for patients and
hospital with insurance companies.
LOCATION: Lancaster, PA
HOURS: Part-time 0.5 FTE (20 hours/week); Monday - Friday, no
holidays, every 6th weekend.
Initial orientation in-house (Lancaster General Hosptial in
Lancaster, PA) then transitioning to a remote position.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability
(with or without reasonable accommodation) to perform the following
- Complete chart review and communicate patient status/medical
needs with insurance companies in order to advocate for patients
and facilitate appropriate reimbursement while meeting tight payor
deadlines, often less than 24 hours.
- Amend patient status and complete order requests to Attending
Physician/Advance Practice Provider urgently.
- Deep and thorough knowledge of clinical process in the Acute
Care setting with the ability to make bold, independent decisions
in regard to patient status and authorization requests.
- Ensure that patients are assigned the appropriate patient class
throughout patient stay by using Industry standard review tools,
department policies, and critical thinking.
- Frequently coordinate with clinical staff to facilitate
appropriate documentation to support patient class, optimal patient
outcomes, and minimize denied days.
- Work closely with physician advisers to provide timely,
accurate and thorough clinical reviews to assist in patient class
- Ability to handle an unpredictable workload shaped by census
and payor demands. - Must be able to complete assignment by end of
day to comply with department standards and payor requests.
- Complete all documentation, including authorizations and
denials according to departmental standard operating
- Communicate with Patient Financial Services staff regarding
changes to patient class to ensure proper billing. - Work with
Financial Clearance and Registration staff to ensure proper
- Facilitate Peer to Peer appeal processes post-denial in a
- Follow up with payers to account for all bed days for
authorization prior to discharge.
- Maintain knowledge of specific payer requirements to ensure
efficient review process.
- Serve as a point of contact/subject matter expert in the
process of outside facilities transferring patients to Lancaster
SECONDARY FUNCTIONS: The following duties are considered secondary
to the primary duties listed above:
- Participates in Continuous Improvement for the department and
- Identifies professional needs to maintain expertise and keep
current with health care trends, both clinical and financial.
- Participates in orientation and education of individuals to the
functions of this position.
- Participate in weekend coverage based on department
- Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS:
- Current licensure as a Registered Nurse, issued by the
Pennsylvania Board of Nursing
- Bachelor's of Science in Nursing, Life Sciences, or Healthcare
- Minimum of five years of nursing experience which includes a
minimum of three years in an acute care hospital setting
- Excellent written, interpersonal communication and negotiation
skills. Strong critical thinking skills and the ability to perform
clinical/chart review efficiently. Strong analytical, data
management and computer skills. Strong organizational and time
management skills, as evidenced by capacity to prioritize multiple
tasks and role components. Ability to advocate for the patient, as
well as the hospital's best interests.
- Ability to adjust/adapt to varying needs of the department and
the ever changing industry requirements
- Ability to work independently and exercise sound judgment in
interactions with the health care team
- Ability to tolerate high volume production standards.
- Knowledge of health care and managed care delivery systems.
This includes standards of medical practice; insurance benefit
structures and related legal/medical issues.
- Knowledge of utilization management and quality improvement
- Experience working within the managed care environment.
-Disclaimer: This job description is not intended and should not be
construed to be an exhaustive list of all responsibilities, skills,
efforts, or working conditions associated with the job. - It is
intended to be a reflection of those principal job elements
essential for recruitment and selection, for making fair job
evaluations, and for establishing performance standards. - The
percentages of time spent performing job duties are estimates, and
should not be considered absolute. - The incumbent shall perform
all other functions and/or be cross-trained as shall be determined
at the sole discretion of management, who has the right to amend,
modify, or terminate this job in part or in whole. - Incumbent must
be able to perform all job functions safely.
Benefits At A Glance:
PENN MEDICINE LANCASTER GENERAL HEALTH -offers the following
benefits to employees:
- 100% Tuition Assistance at The Pennsylvania College of Health
- Paid Time Off and Paid Holidays
- Shift, Weekend and On-Call Differentials
- Health, Dental and Vision Coverage
- Short-Term and Long-Term Disability
- Retirement Savings Account with Company Matching
- Child Care Subsidies
- Onsite Gym and Fitness Classes
PENN MEDICINE LANCASTER GENERAL HEALTH -is an Equal Opportunity
Employer, committed to hiring a diverse workforce. All openings
will be filled based on qualifications without regard to race,
color, sex, sexual orientation, gender identity, national origin,
marital status, veteran status, disability, age, religion or any
other classification protected by law.
Search Firm Representatives please read carefully: PENN MEDICINE
LANCASTER GENERAL HEALTH -is not seeking assistance or accepting
unsolicited resumes from search firms for this employment
opportunity. Regardless of past practice, all resumes submitted by
search firms to any employee at PENN MEDICINE LANCASTER GENERAL
HEALTH -via-email, the Internet or directly to hiring managers at
Penn Medicine Lancaster General Health in any form without a valid
written search agreement in place for that position will be deemed
the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no
fee will be paid in the event the candidate is hired by PENN
MEDICINE LANCASTER GENERAL HEALTH -as a result of the referral or
through other means.
Keywords: Lancaster General Hospital, Lancaster , RN Utilization Management Specialist-Admissions (Remote) (Part-Time/Day Shift), Executive , Lancaster, Pennsylvania
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