Utilization Management Specialist, Revenue Integrity and Utilization
Full Time, 80 Hours Per Pay Period, Day Shift
Covenant Health Overview:
Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.
Position Summary:
The Utilization Management Specialist I will perform utilization management functions to include medical necessity reviews to promote a utilization management program. The UM Specialist prepares and reviews necessary documentation for insurance utilization management processes and coordinates communication between members of the UM team to ensure timely follow through for status placement. The UM Specialist collaborates with attending physician if ambiguous documentation pertaining to patient status placement requires clarification. The UM Specialist utilizes electronic utilization management database for documentation of interventions and communications so as to ensure accurate reporting. Collaborates with patient account services, physicians, care coordinators, physician advisors and facility departments as related to utilization management. Communicates with hospital and payor medical directors in order to correctly determine the medical necessity of patient status with a patient advocacy focus.
Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386
Minimum Education:
None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a HS diploma or GED.
Minimum Experience:
At least two (2) years of utilization management, case management or equivalent experience.
Licensure Requirements:
Current Tennessee LPN license is preferred
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