Utilization Review Assistant - FT Days

Core Competencies

• Acts as a liaison for the department, fostering clear communication and collaboration with other hospital departments, physicians, office staff, and other relevant stakeholders.
  
  
• Composes list of resources for Case Managers and Social Workers as needed.
  
  
• Confers with assigned nurse regarding need for any additional hospital services or referrals and assists with referral process, if needed.
  
  
• Coordinates department statistics and forwards information to budget department and director.
  
  
• Delivers daily the QI0 2nd letter to MCARE patients 48 hours prior to DC for compliance with the CMS.
  
  
• Ensures payer communication with reference #s and authorizations for benefits coverage for any outside services including MCARE.
  
  
• Reports errors, knowing that Torrance Memorial engages in a positive environment for the correction of errors (Non-punitive)
• Works collaboratively with other departments and teams (i.e. Physician Advisor, Case Management, Business Office, Patient Access, Physician Offices, etc.) to mitigate potential denials.
• Ensures completion of timely and accurate payer and repatriation documentation, retrospective review requests, WQM management, and post-stabilization documentation.
• Responds to audit requests timely and escalates to the appropriate team for review and response (HIM, Risk Management, Physician Advisors, Leadership, etc.)

Experience

Compensation Range

$25.13 - $37.96 / Hour