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Utilization Management Specialist, Full Time Richland

Prisma Health
United States, South Carolina, Columbia
Jan 23, 2025
Inspire health. Serve with compassion. Be the difference. Job Summary Provides clerical and data management support. Collects and summarizes routine operational and productivity data. Collects and enters data for assigned patient populations. Obtains authorizations for treatment and makes referrals where appropriate. Assists with administrative duties. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Runs daily, weekly, monthly and quarterly reports Obtains and submits appropriate clinical documentation to the payors. Responds to payor requests for additional documentation timely and accurately. Updates and maintains authorization numbers and approved days in registration and/or case management systems Obtains appropriate statistical data for patients in assigned patient population areas and communicates data to payors Enters payor denial data into denial management or case management system Answers, screens and prioritizes telephone calls, utilizing sound judgement regarding the urgency and content of the information Processes faxes to and from payers for the Case Management team as assigned. Secures discharge dates for payers. Provides assistance with the discharge planning process including but not limited to sending information to receiving information from appropriate vendors/providers. Ensures all data entry is completed timely and accurately. Ensures payor communication is completed timely and accurately. Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - High School diploma or equivalent. Associate degree in Business or Healthcare related field of study preferred Experience - Two (2) 2 years clerical or administrative experience In Lieu Of NA Required Certifications, Registrations, Licenses NA Knowledge, Skills and Abilities Basic understanding of common medical and financial terminology - Preferred Work Shift Day (United States of America) Location 3 Medical Park Rd Richland Facility 1510 Richland Hospital Department 15107180 EEG and Sleep Lab Admin Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.