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Utilization Management Specialist - Case Management

Company: Seton Family of Hospitals, TX
Location: Austin
Posted on: April 17, 2018

Job Description:

Job ID: 247957 Utilization Management Specialist - Case Management Austin, Texas Regular / Day Additional Job Information Title:--Utilization Mgmt Specialist City, State:-- Austin,TX Location:-- Chevy Chase Bldg Department:---- Case Management 001 Additional Job Details:----PRN,Day,--0 hours,Weekly Marketing Statement At Seton, we---re using the power of purpose to change healthcare--for the better. --As part of Ascension's Texas Ministry Market we do this through collaboration. Seton brings great minds and proven results from the across the nation together. From the best hires and strategic plans for growth, to the proactive connections we make within our community, we reach out to move ahead. Now, partnering with the University of Texas to build the new Dell Seton Medical Center, our future looks brighter than ever. We do this in force. With more than 12,800 associates, Seton is the leading healthcare service provider in Central Texas as well as its second largest employer. We serve an eleven county area of more than 1.8 million people. We have five urban acute care hospitals, two rural hospitals, a mental health hospital, three primary care clinics for the uninsured, and an increasing number of storefront care locations. We do this with vision. Since our founding in 1902, Seton has led the way in Austin --- expanding thoughtfully and with purpose; caring for our neighbors, because we know them so well. As a non-profit with a mission --- rather than a bottom line --- guiding us, improving health at a community level is our number one priority. Austin. It---s our home, and our heart. Located at the center of Texas hill country --- just a few hours from Dallas, Houston, and San Antonio --- Austin offers an appealing blend of hometown comfort and high-tech care. Whether you are looking for a vibrant nightlife and live music, recreational areas and activities, family-friendly fun, or educational offerings, Austin is a city that not only calls to you, but gently encourages you to sit down and stay awhile. With cultural diversity, a mild climate (and truly great outdoors), attractive and affordable housing options, and no state income tax, Austin is a feel-good choice for a rewarding way of life. The way we connect, the lives we affect. The Seton Healthcare Family is always looking for dedicated, talented professionals willing to share their hearts with those we serve. Being part of our close-knit team means performing to a higher standard. Embracing innovation, while understanding the importance of individual connections. And continually collaborating, learning and growing to realize new levels of personal and professional satisfaction. -- Job Description Job Summary: Provides various services supporting case management process. -- Responsibilities:

  • Obtains and records authorizations for ancillary services and denial reporting.
  • Facilitates, identifies and documents all referrals, along with patient choice, to appropriate facilities or agencies.
  • Expedites discharges by transmitting appropriate documentation to providers for acceptance of patient. Documents all interactions with payers and communicates status with appropriate staff.
  • Communicates status with Case Management staff and arranges for patient transfer. Functions as a key point of contact between Case Management staff, admissions and payers.
  • Functions as a key point of contact between clinical case management staff and payers.-- Delivers accurate clinical information to payors to obtain authorization for appropriate level of care and length of stay.-- Documents concurrent and retrospective denials and sends to appropriate areas.----
  • Documents all interactions with payers to enhance operational efficiencies and communicates this information to appropriate Case Management staff.-- Communicates changes in payer information to admissions and Case Management staff.-- Identifies concurrent denial issues and promptly notifies Manager.
  • Enhances department growth by support of and participation in the development and implementation of department goals and activities.-- Identifies innovative approaches and takes action accordingly.
  • Supports other members of the Coordinated Care Resource Center, functioning as backup when needed.-- Acts as a liaison to share patient specific insurance or referral issues to the appropriate staff member.
  • Performs other duties as assigned.
  • May be required to be "on-call."
    Qualifications Education:
    • HS or Equivalent--
    • High school diploma or equivalent is required Associate degree in human services related field or Bachelor---s degree in health care field is preferred. Work Experience: Two (2) years of related health care experience is required. Related college coursework may substitute for the required experience on an equivalent year-to-year basis. -- Equal Employment Opportunity Seton Healthcare Family is an equal employment opportunity / Affirmative Action employer and complies with all applicable federal, state and local equal employment regulations and laws. It is the policy of the Seton Healthcare Family to afford equal employment opportunities to all employees and prospective employees without regard to their race, color, ancestry, religion, sex, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, gender identity or expression, or any other characteristic or status that is protected by federal, state, or local laws. This policy applies to all personnel actions, such as hiring, promotion, transfer, demotion, termination, layoff and all other conditions and privileges of employment in accordance with applicable federal, state, and local laws. Affirmative Action goes beyond the concept of equal employment opportunity. Affirmative Action policies and programs are required to overcome the present effects of past discrimination and to achieve equal employment opportunity for members of groups that are or have been formerly under-represented. Affirmative Action policies and programs are tools whereby additional efforts are made to recruit, employ and promote qualified members of formerly excluded groups, even if that exclusion cannot be traced to particular discriminatory actions. Through specific and result-oriented activities, Seton Healthcare Family---s goals are to ensure that every person is given full consideration through equal employment opportunity policies and practices and to achieve a representative workforce through its affirmative action efforts.-- It is further the policy of the Seton Healthcare Family to encourage vendors, contractors, affiliate institutions and others doing business with the Seton Healthcare Family to observe the principles of Equal Employment Opportunity and Affirmative Action. -- Seton Healthcare Family is an EEO/AA employer: M/F/Disabled/Vet. For further information regarding your EEO rights, click on the following link to the ---EEO is the Law--- poster: EEO is the Law Poster Supplement -- Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. Share: -->

      Keywords: Seton Family of Hospitals, TX, Austin, Utilization Management Specialist - Case Management, Executive, Austin, Texas

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