Utilization Management Coordinator-MSH-Case Management-Full Time-Days

Strength Through Diversity Ground breaking science. Advancing medicine. Healing made personal. Roles & Responsibilities: This position is responsible for coordinating requests for clinical information from Third Party Payors and providing support to a broad client base, both internal and external to the Institution. The position also facilitates and tracks concurrent adverse determinations and collaborates with Appeals Management in management in management of retrospective denials. Duties and Responsibilities: 1. Receives and appropriately enters requests for reviews into Canopy. 2. Enters certification and denial data into canopy based on review of payor End of Day Reports, notification from internal and external Case Managers, financial screening and other personnel within required time frame. 3. Generates and distributes Payor Census Logs to external and on-site Case Managers. 4. Assist with denial management and Discharge Appeals process. 5. Contacts third party payers to assist case managers in obtaining authorization for Discharge Planning 6. Responsible for incoming communications via phone or fax, monitors office voice mails. 7. Prioritizes incoming communications and relays messages to Case Managers or other UM staff. 8. Provides patient-specific information to payors as needed. 9. Screens and registers outside agency personnel in compliance with HIPAA regulations. 10. Performs other daily tasks associated with Canopy, TDS/EDR, Cerner and Eagle 11. Maintains office files, equipment and supplies. 12. Performs other duties as assigned Requirements: Education: Some college is preferred; Bachelor’s degree with coursework in business strongly preferred, or combination of relevant work experience and education Experience: Familiarity with Third Party Payor requirements preferred. Strength Through Diversity The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by: Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers We work hard to acquire and retain the best people and to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong, and are able to professionally advance. We share the belief that all employees, regardless of job title or expertise, contribute to the patient experience and quality of patient care. Explore more about this opportunity and how you can help us write a new chapter in our history! Who We Are Over 42,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve. Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai. The Mount Sinai Health System (MSHS) provides equal employment opportunity to all its employees and applicants for employment without unlawful discrimination on the basis of their actual or perceived race, creed, color, religion, national origin, sex, gender, gender expression, gender identity, age, disability, marital or parental status, sexual orientation, veteran, immigration, citizenship, or other protected status. EOE including Veterans and Disabled