LPN Utilization Mgmt Reviewer - Medical Social Services - Full Time - Guthrie Healthcare : Job Details

Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for reimbursement of patient care services. The responsibilities include: Facilitating communication between physician offices, payers, Care Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and to assist in ensuring generation of clean claims in a timely manner Securing authorization as appropriate Documenting payer authorization Facilitating issue resolution with payer sources in collaboration with other hospital departments or clinic offices as appropriate Demonstrating ongoing competence in payer requirements, as defined collaboratively w...Social Services, LPN, Medical, Medical Director, Hospital, Healthcare