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Utilization Management Representative
@581 Advocate Aurora Health, Inc.
[Hiring] Utilization Management Representative @581 Advocate Aurora Health, Inc.
Mar 22, 2025 - 581 Advocate Aurora Health, Inc. is hiring a remote Utilization Management Representative. 💸 Salary: $20.40 - $30.60 per hour. 📍Location: USA.
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Role Description
The Utilization Management Rep (UM Rep) is responsible for completing routine, frontline clerical duties and administrative work necessary to support the daily operations of the Utilization Review Department.
- Manage incoming fax, phone, and portal communications or any other requests from internal and external customers pertaining to clinical requests, approvals, authorizations, and denials; determine action required, and document all activities performed accurately and clearly in the designated database/area(s) of EHR.
- Communicate clinical needs, authorizations, and denials to the Utilization Review Nurses and Managers for follow up.
- Verify insurance information provided by callers, fax, or Portal and send information to payers as requested, including discharge dates and disposition or clinical reviews/summaries prepared by UM RNs (if directed to do), while ensuring that all actions taken align/comply with the confidentiality and HIPAA compliance guidelines.
- Follow up with payers to validate the authorization and confirm the days approved, and capture approved days in the EHR.
- Enter data into database, spreadsheets, and perform analysis as directed.
- Provide efficient, courteous, and expert customer service to all internal and external callers.
- Open, sort, and process incoming mail/correspondence directed to the Utilization Review.
- Maintain the department records and files.
- Ensure provider compliance with Patient Status Admit Order (PSAO) co-signatures across the hospital sites covered by centralized UM.
- Utilize standard reports/patient lists within the EHR to identify PSAO co-signature delinquencies and follow up with reminders/escalations to physicians to sign admission orders.
- Follow the standard process to notify treating physician via perfect serve or other approved/designated methods of communication.
- Interact with Site and System Physician Advisors based on guidelines for escalation.
- Document all actions taken and status updates in the EHR.
- Maintain PSAO spreadsheet to track signature requests.
- Provide support and instruction to physicians to assist in the LOC order signature process.
Qualifications
- High School Graduate or equivalent and 4+ years secretarial experience or Associates Degree
- 2+ years of secretarial experience – preferably in a medical environment
Requirements
- Competent in advanced functions with Microsoft Outlook, Word, Power Point, Excel and complete basic reporting
- Type 55+ words per minute
- Strong critical thinking and communication skills to problem solve, and interact with colleagues, physician and payers.
- Ability to foster and maintain effective professional relationships, manage conflict while demonstrating Advocate Aurora’s Behaviors of Excellence at all times
- Ability to be flexible and function well in a fast paced, continually changing environment.
- Assume responsibility for self-development by seeking out opportunities for growth and be an active participant in department, site and system initiatives.
- Comply with strict adherence to predetermined procedures and processes, safety, compliance and privacy/HIPAA guidelines.
Benefits
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
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| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
Customer Service
Customer Service
|
Salary
💸
$20.40 - $30.60 per hour
|
Remote
Location
USA
|
|
Job Type
part-time
|
Posted
Mar 22, 2025
|
️
| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
