Catholic Health Initiatives Utilization Review Specialist in LEXINGTON, Kentucky

Utilization Review Specialist

Description

Position Summary: Verifies information pertaining to patientinsurance as obtained from Pre-registration and registration for multiple facilities.Maintains all Inpatient, OPO and OPP payer requirements and precertification.Documents all clerical information into the appropriate systems to supportUtilization Review team for several facilities. Distributes admission documentsto appropriate staff and payers. Assists UR Clinical staff members, for severalfacilities, in the communication with insurance agencies which will beessential in order to meet the requirements needed by the payers. Reviews and revises status changes withinmultiple systems for several facilities. Assist in compiling statics fordepartments reports for multiple facilities. Be able to work withoutsupervision on multiple levels in regards to the department and staffing needs.Displays a positive image of St. Joseph Health System by demonstratingcourteous and professional behavior toward patients, physicians, visitors andother employees. Performs other duties as instructed by Department Director orManager.

Qualifications

Requirements: Must have High School diploma or GED. Previous experience required. Excellentinterpersonal skills, including the ability to communicate professionally bothverbally and in writing. Good understanding of interpersonal dynamics withability to be collaborative and creative. Knowable of hospital systems, medicalterminology and medical documentation. Analytic and problem solving killsessential. Willingness to maintain a flexible work schedule as needed. Computerskills essential.

AdditionalResponsibilities:

  • Demonstrates a commitment toservice, organization values and professionalism through appropriateconduct and demeanor at all times.

  • Adheres to and exhibits ourcore values: Reverence : Having a profound spirit of awe and respect for allcreation, shaping relationships to self, to one another and to God and acknowledgingthat we hold in trust all that has been given to us. Integrity : Moral wholeness, soundness, uprightness, honesty andsincerity as a basis of trustworthiness. Compassion : Feeling with others, being one with others in theirsorrows and joys, rooted in the sense of solidarity as members of thehuman community. Excellence : Outstanding achievement, merit, virtue; continuallysurpassing standards to achieve/maintain quality.

  • Maintains confidentiality andprotects sensitive data at all times.

  • Adheres to organizational anddepartment specific safety standards and guidelines.

  • Works collaboratively andsupports efforts of team members.

  • Demonstrates exceptionalcustomer service and interacts effectively with physicians, patients,residents, visitors, staff and the broader health care community.

Catholic Health Initiatives and its organizationsare Equal Opportunity Employers

Job Administrative/Clerical

Primary Location KENTUCKY-LEXINGTON-SAINT JOSEPH HOSPITAL

Daily Schedule 8am

Scheduled Hours per 2-week Pay Period 80

Weekends Required Occasional

Req ID: 2018-R0169615

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.