Providence Utilization Review Specialist in Kodiak, Alaska
Providence is calling a Utilization Review Specialist (Utilization Review, Day Shift, 0.0 FTE / On Call) to Providence Kodiak Island Medical Center in Kodiak, Alaska. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all - especially those who are poor and vulnerable.
Apply Today! All applicants that meet qualifications will receive a text with some additional questions from our Modern Hire System.
In this position, you will:
Embrace the Providence Service Standards in all aspects of position. Present and conducts self in a professional manner. Provide support to coworkers and customers while demonstrating service excellence by building positive interpersonal relations to ensure productive and positive relationships are maximized. Develop a deep understanding of customer’s perspectives and needs and works to meet their expectations. Builds a culture of true caring by behavior and interactions with others
Communicate in a compassionate and professional manner. Demonstrate professional interpersonal and verbal skills when communicating with other department and of the care delivery team to provide optimal continuity of care to patients and their families. Is able to communicate effectively with a wide variety of people from differing literacy levels, languages and cultures. Demonstrate commitment to teamwork and interacts harmoniously with others to ensure team success. Support new orientees in learning department routines
Demonstrate effective priority setting and organization skills to promote departmental workflow and cost efficiency. Ensure smooth, efficient services and maximizes comfort and confidentiality for the patient. Anticipates potential obstacles and adjusts work assignments to prevent unnecessary delays. Recognize errors/problems and takes corrective action when necessary. Utilize available resources to recognize errors/problems and takes corrective action and assists with problem resolution
Demonstrate knowledge and support of quality improvement goals. Participate in department, facility and organizational projects or committees as assigned
Ensure verification of insurance eligibility. Identify services and payers requiring authorization and ensures required authorizations are in place. Identify services requiring referrals/consent forms and ensures they are signed and in place. Validate motor vehicle accident, workman’s compensation or other third party liability paperwork has been completed. Process real time eligibility and assigned denial work queues timely and accurately. Maintain current knowledge of and competency with numerous Federal, State and other regulatory body compliance regulations and third-party insurance plans
Assist with external review companies, agencies, and consultants, using advocacy and negotiating skills that address medical necessity and appropriateness of inpatient/outpatient levels of care. Assist department with tracking and managing length of stay, avoidable days, denials and appeals of inpatients/outpatients. Assist in obtaining required authorizations for inpatient admissions
Required qualifications for this position include:
High School diploma or equivalent
Basic Life Support (BLS) certification within 90 days of hire
Preferred qualifications for this position include:
Associate’s degree in a clinical healthcare or business field
1 year of utilization review experience
Knowledge of medical terminology
Knowledge of CPT and ICD10 coding
Knowledge of State, Federal and other regulatory compliance regulations, including Medicare, EMTALA and ABN
Experience with Epic
About Kodiak Island Medical Center
Providence Kodiak Island Medical Center (PKIMC) provides comprehensive health care to residents and visitors of Kodiak Island. This critical access hospital features 25 acute care beds, including four birthing suites, one OB triage room, and two ICU beds. In addition, the Elder House, PKIMC’s long term care facility, has 22 beds.
PKIMC provides an extensive array of inpatient and outpatient services, including emergency department, surgery, laboratory services, maternity, general medicine, physical therapy, occupational therapy, respiratory therapy, sleep studies, specialty clinics, diagnostic imaging services and pharmacy and is staffed by a mix of primary care physicians, surgeons and specialists who provide family practice, internal medicine, obstetrics, radiology and general practice.
For more information regarding Providence Kodiak Island Medical Center, please click on the following link: http://providence-kodiakhealthcare.jobs/
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Schedule: On Call
Job Category: Administrative (Clinical)
Req ID: 294119