Program Coordinator-Utilization Management-2

Job Description Summary

Provide non-clinical administrative support to the Utilization Management process including but not restricted to timely utilization management.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC004927 SYS - System Case Management

Pay Rate Type

Hourly

Pay Grade

Health-25

Scheduled Weekly Hours

40

Work Shift

Job Description

Responsibility A: Provides department-related and other appropriate communications to internal and external customers.

• Provides professional, efficient and courteous service to the customer while maintaining integrity in dealing with issues of a confidential nature.
• Works effectively with peers, nursing and medical staff and maintains a positive attitude. Responds to requests personally, tactfully, and courteously.
• Obtains information required for response whenever possible and communicates pertinent information to staff, customers, and providers. Relays messages to appropriate individuals efficiently and in a timely manner.
• Promotes a positive work environment and contributes to the overall team effort.
• Assists with other department duties as assigned

Responsibility B: Provides assistance for utilization management processes to maintain compliance with federal, state and managed care guidelines.

• Receives initial /concurrent review requests, faxes or digitally transmits updated review to payer (if available) and refers outstanding issues to Utilization Manager.
• Reviews and distributes payer authorizations and requests for review.
• Completes timely transmittal of collected clinical information to payer representatives.
• Refers denial notifications to Utilization Manager for assessment and submission to  physician advisor (as appropriate).

Responsibility C: Maintains data integrity.

• Performs data entry of information obtained from Utilization Managers as directed
• Maintains all assigned databases to ensure data is complete and accurate.
• Observes, maintains, and follows confidentiality and compliance requirements when communicating patient information.

• Knowledge of utilization management processes, working knowledge of payer processes, payer requirements and vocabulary.

• Ability to operate a computer, electronic medical record, fax machine, photocopier, and multi-line telephone.
• Excellent customer service skills, and phone etiquette are required.
• Ability to handle high volume of calls and perform more than one task at a time in a professional manner.
• Be a team player.

Additional Job Description

Education and Experience: Bachelors Degree and 2 years work experience; or High School Diploma (or equivalent) and 5 years experience required.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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