SUPV - UTILIZATION REVIEW & AUTH
Sparrow Health System
Lansing, Michigan 48901

Job Description

Positions Location: Lansing, MI

 

Job Description

 

General Purpose of Job:

Assist in managing the department’s operations related to Utilization Review, Inpatient Medical Authorization, and appeal of denied reimbursement for medical care.  Assists the Manager in supervising the professional staff of Continued Stay Specialists, Pre-Service Specialists, Audit and Appeals Specialists and Support Staff.  In collaboration with the manager, the Supervisor ensures that quality professional and nonprofessional services are provided to patients at the level that the patient requires.  Envisions the future for the department; produces excellence; leads by influence; and develops associates within the department.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis.  Caregivers may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

  • Assists in managing department operations to insure framework for optimal patient length of hospital say in coordination with appropriate recuperative needs.
  • Assist in managing the medical staff utilization management function.  Work closely with the Physician Advisor(s).  Assists reporting requirements, responding to reports, audits and denial of payment from external payers and reviewers.
  • In collaboration, selects caregivers for UR Nursing, Patient Finanical Counselors and Support Staff.  Trains, supervises, counsels, and evaluates all staff.  Assists in scheduling staff to optimize efficiency and effectiveness.  Provides staff with support, encouragement and motivation to perform job duties in optimal manner.
  • Develops and maintains department policies related to Utilization Management and assists in development and maintenance of polices related to general department operations, Utilization Review and Patient Financial Counselling.
  • Participate in department Performance Improvement, Corporate Compliance, Caregiver Engagement initiatives and monthly reporting of key operational information.  Identifies opportunities for improvement.  Plans and implements strategies to improve department operations.
  • Provides education to department staff, physicians, other hospital departments and others related to department operations and responsibilities.
  • Assists in the development of department budget, goals and objectives.  Develops and implements plans to achieve goals.  Participates in efforts to support and advance the mission, vision, strategies and goals of the Health System.
  • Participates in establishing policies and procedures, position descriptions, staffing needs and productivity,
  • Assists in the development and implementation of special projects.
  • Serves as a role model for consistent demonstration of Sparrow Health System’s Vision, Mission and Values along with the Customer Service Behavioural Standards of Performance by respecting the Privacy and Confidentiality of those we serve.
  • Demonstrates knowledge and respects patient, service provider, organizational confidentiality and HIPAA Security procedures and protocols as defined under the HIPAA Privacy and Security Procedures.
  • Follows established HIPAA privacy procedures when using and/or disclosing protected health information

Job Requirements

General Requirements * Current Michigan Nursing License
Work Experience * Minimum of five years’ experience in an acute care hospital as a Continued Stay Utilization Review Specialist * Previous supervisory experience (Preferred) * Computer skills in word processing and spreadsheet software (Preferred) * Analytical skills necessary to collect tabulate and analyse data to determine and implement effective action and solutions (Preferred) * Experience with Interqual, Two Midnight Rule, and Authorization requirements (Preferred)
Education * Graduate of an accredited Nursing program * Bachelors/Associates Degree in Healthcare related field
Specialized Knowledge and Skills * Demonstrates strong written and verbal communication skills * Ability to work independently * Demonstrates excellent Utilization Review knowledge * Maintains an atmosphere that supports and encourages high performance, high levels of caregiver engagement, teamwork, customer and service and continual improvement within a specific area of responsibility * Strongly supports the direction of Sparrow and the members of the Sparrow team * Willingness to learn new skills * Strong analytical skills * Demonstrate ability to manage multiple priorities and strong attention to details * Understanding of payor specific criteria

 

Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

JOB REQUIREMENTS: To apply for this position, please copy and paste the following link into your browser address bar: http://sparrowrccorp.peoplefluent.com/viewjob.html?erjob=4833:en_US

Preferred Years Of Experience:

5 Year(s)

Education Required:

2 Year Degree - AA
Date Posted : 10/28/2018