Utilization Review Specialist

Pay: $32.00 – $45.00 per hour

Job description:

SIGN ON BONUS- $10,000

Duties and responsibilities included:

This position focuses primarily on insurance authorization management, payer communication, reimbursement support and coordination with the business office. Anyone with experience with insurance updates and a background in nursing, social work, or therapy is qualified.
Coordinates between St Augustine Manor, insurance company, and Resident. Provides updates to insurance company on a Resident’s health status, therapy progress, discharge planning, changes in condition, etc to help ensure continued insurance coverage to meet our Resident’s needs.
Timely updates to St Augustine staff on changes to insurance coverage so appropriate planning for Resident’s discharge or further stay can be implemented such as insurance authorizations, updates, and denials.
Works alongside the nursing MDS department to complete assessments, maximize reimbursement, and maintain compliance for state & federal regulations, completing accurate MDS & care plans as assigned.
Understand recertification documentation and communication with managed care plans.
Knowledge of NOMNC, appeal process, reconsideration, LOC and long-term authorizations required.
Attends meetings: weekly utilization review and monthly triple check.
Collaborating with admissions, therapy, social services, and business office teams.
Requirements:

Experience with MDS, Medicare, managed care or utilization review preferred.
Must be able to work Monday-Friday 8:30am-5pm.
Weekend availability to check emails for after hour/weekend NOMNCS.
Ability to work independently and manage multiple priorities.
Must have prior MDS 3.0 experience.
Must be highly organized, professional, and motivated.
Must have solid computer skills.
Excellent communication skills.
Should be friendly and a team worker
Experience:

MDS 3.0- 2 years required
Long term care- 2 years required
Schedule:

8-hour shift

Day shift

Benefits:

401(k)
401(k) matching
Dental insurance
Disability insurance
Employee assistance program
Flexible schedule
Flexible spending account
Free parking
Health insurance
Health savings account
Life insurance
Paid time off
Tuition reimbursement
Vision insurance

Work Location: In person