UM Assist

Job Summary

The Utilization Review Assistant supports the UM Nursing department systemwide with non-clinical duties, tasks, and functions within the department to ensure these duties are performed timely. This employee is responsible for selected functions related to general clerical work and support duties that may include work flow maintenance, private and governmental payer authorization related processes, maintaining electric filing system, performing data entry, preparing correspondence, processing documents, managing schedules, answering multi-line phone systems, scanning, faxing, coping, and non-clinical EPIC documentation related to obtaining authorizations. The Utilization Review Assistant will assist UM Nursing team to close EPIC cases that require non-clinical interventions. Training is available.

Core Responsibilities and Essential Functions

Assessment / Clerical Support

• Answer multi-line incoming phone calls, forward calls as appropriate, and review voicemail boxes hourly.
• Produce, distribute, receive, review, and process all faxes and process per protocol.
• Develop and maintain electronic files for incoming communications and disseminate as appropriate.
• Research and create presentations as needed.
• Communicates with appropriate UM Nursing team members related to departmental related duties.
• Prepare and monitor invoices as needed.
• Handle all confidential information in a professional manner.
• Take minutes for departmental staff meetings.
• Monitors for compliance of Medicare/Medicaid regulations, including delivery of MOONs and associated mailing.

EPIC Workflow/Disposition Planning

• Supports the UM Nursing team with assigned functions in EPIC work que space related to obtaining timely authorization information and coordinates with UM Nursing team.
• Escalating denial information received immediately to UM Nursing team.
• Develop and maintain contact list.
• Understands eligibility processes and criteria for both private and government payers. Places call to payers to update and document authorization information in a timely manner.
• Search payer web portals to update and document authorization information in a timely manner.
• Generate EPIC and other reports as needed.

Documentation

• Document all attempts made to obtain authorizations by phone, fax, or web portal.
• Document receipt of all incoming calls, faxes, or other communicated information related to Centralized UM department activities.
• Document escalation of all denial related communications to UM Nursing team in a timely manner.
• Communicates steps taken and determinations provided by insurance payers/web portals in a timely manner.
• Document the authorizations obtained in the Electronic Health Record.
• Document efforts made to regarding reconsideration efforts with all denials when received.
• Must provide sufficient and appropriate documentation required by GAMMIS for Medicaid pre-cert approvals on the GAMMIS portal.

Professional Development and Initiative

• Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.
• Develop administrative support staff by providing information, educational opportunities and experimental growth opportunities.

Performs other duties as assigned. Complies with all WellStar Health System policies, standards of work, and code of conduct.