JOB SUMMARY: The Utilization Management (UM) Support Specialist I will assist with performing support and clerical duties to the Utilization Management Department.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES: The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification with or without an accommodation. It is not necessarily descriptive of any one position in the class. The omission of an essential function does not preclude management from assigning duties not listed herein if such functions are a logical assignment to the position.

• Maintain pre-established review parameters under UM Coordinator. Identify and document comparisons with community standards, regionally based as indicated
• Communicate and document any issues relating to the outpatient/inpatient UM process to the UM Coordinator. Assist with the data collection and reporting related to the UM outpatient/inpatient process.
• Assist with regular Utilization Reviews and Prior Authorizations under the direction of the UM Coordinator
• Responsible for typing, scanning, answering the telephones, entering information into UM spreadsheets, making copies, updating, printing and distributing reports, opening and sorting mail and filing tasks.
• Willingness to start early in the morning to review inpatient packets and complete data entry to enable UM staff to facilitate review, denial, and appeal processes
• Must be computer literate. Able to type data in an accurate and timely manner. Demonstrates good verbal and written communication skills. Displays excellent telephone and customer service skills.
• A pleasant and friendly manner is vital to satisfactory job performance. Must display patience and understanding of potentially difficult consumers. Must be alert and vigilant at all times. Dependability and adaptability essential for this position. Must show initiative and be able to work autonomously.
• Maintains a professional atmosphere. Provides excellent customer service. Maintains good working relationship with center, as well as, facility staff and external agencies. Works with staff practitioners to coordinate pharmacological management. Maintains current records, logs.

COMPETENCIES: Knowledge, Skills, Abilities, and Motivation (KSAM) required for an employee to be successful.

• Serving Our Consumers: Effectively meeting consumer needs, building productive consumer relationships, and taking responsibility for consumer satisfaction and loyalty.

• Consumer Focus: Building strong consumer relationships and delivering consumer-centric solutions.
• Values Differences: Recognizing the value that different perspectives and cultures bring to an organization.

• Effective Communication: Clearly conveying information and ideas to individuals and groups in a manner that engages the audience and helps them understand and retain the message.

• Communicates Effectively: Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
• Manages Conflict: Handling conflict situations effectively, with a minimum of noise.

• Continuous Improvement: The ongoing process of achieving positive changes in service and processes in order to improve efficiency and quality.

• Resourcefulness: Securing and deploying resources effectively and efficiently.
• Cultivates Innovation: Creating new and better ways for the organization to be successful.

• Expertise: Demonstrating proficiency of an employee's skill or knowledge within their field of practice.

• Drives Results: Consistently achieving results, even under tough circumstances.

JUDGMENT/DECISION MAKING: Ability to exercise good judgment in potential crisis situations, patient and family conflict situations, etc. Must utilize judgment in a manner that will favorably promote the Center through actions and interactions with others.

EDUCATION & EXPERIENCE:

• Education:

• High School Diploma or equivalent required

• Experience:

• Minimum of One (1) year experience working in a UM, HIM, or Clerical department required
• Proficiency in working with computer systems such as spreadsheets, email, and medical records systems required
• Minimum of Two (2) years’ experience with both inpatient and outpatient review process preferred
• Experience with medical billing and/or Medicaid preferred

TRAINING & DEVELOPMENT: Completes all administrative and competency requirements as outlined in the Individual Training Plan. Other training and/or professional development may be assigned due to evolution of programs.

POSITION CONTENT: This job description is not intended to be and should not be construed as an all inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, Management reserves the right to modify, and/or remove duties and assign other duties as necessary.