• Location: Bethlehem, PA
• Type: Contract
• Job #83230

APR Consulting, Inc. has been engaged to identify a Utilization Management Partner
 
Location: Bethlehem, PA 18017
Position: Utilization Management Partner
Pay Rate: $23/hr
Duration: 8 weeks
Expected Shift: M-F; 8AM – 4:30PM, 40 hrs/week
Location: Onsite
Dress Code: Business casual
 
 
JOB SUMMARY
Responsible for the compliant, accurate and timely delivery of Observation Notifications directly to patients and/or their
families/representatives while hospitalized under Observation Status/Patient Class. Responsible for other payer-based forms,
including but not limited to ADAR forms. Assists Utilization Management (UM) team by acting as a bridge between the
patient/family/representative and the UM team, as well as the Interdisciplinary team for the purposes of communication related to
health insurance communication, requirements and related information. Prioritizes coverage at largest hospital site. Works highly
collaboratively with the IP Care Management team on-site. Also responsible for working collaboratively with UM teammates to
perform administrative and operational functions within the UM Department. Provides support to UM teammates by ensuring
appropriate communication with insurance payers as well as related documentation within payer-specified timeframes. Performs
clerical duties including but not limited to: Notitication of Admission of hospitalizations, faxes, online payer databases, voicemail
coverage, discharge notifications, determinations, etc in the UM department following established standards and practices,
adhering to UM policies and standards. This position is fully on-site.
 
JOB REQUIREMENTS:
 
• Bachelor’s Degree
• 3 years Billing, health insurance, physician practice, case management, healthcare-related field, or equivalent operations.
– Customer service experience
– Epic experience
– Knowledge of Medicaid and insurance
– Ability to work independently as job requires much of the duties to be performed solo
 
Experience – Preferred
• 3 years Hospital and/or insurance industry.
 
Knowledge, Skills and Abilities – Required
• Ability to complete data entry, communicate clearly & accurately both in written and verbal communication.
• Knowledge of electronic medical records (EMR) and medical terminology.
• Ability to interact effectively & professionally with all key stakeholders, members of the interdisciplinary team and with all
Colleagues, as well as with all patients/families/representatives.
• Ability to take direction, offer useful insight into work processes & brainstorm when challenges arise. Strong ability to
work collaboratively. Strong organizational skills.
• Demonstration of strong critical thinking and clear communication skill set, as well as ability to demonstrate flexibility,
teamwork as well as a high level of autonomy.
• Demonstration of ability to multi-task, prioritize/reprioritize as the day's work changes, as well as to assist others when
work tasks are completed, involve leadership when challenging situations arise, and conduct oneself in a professional
manner at all times through all interactions.
 
Knowledge, Skills and Abilities – Preferred
• Bilingual in English and Spanish.
 
JOB FUNCTIONS:
 
• Provides compliant, accurate and timely delivery of appropriate Observation Notification directly to
patients/families/representatives while hospitalized under Observation Status/Patient Class. Delivers other payer-
based forms as warranted. Documents all related information according to departmental policy and procedure.
Prioritizes coverage at largest hospital site.
50%
• Ensures smooth utilization management department functioning which includes answering phones,
communicating effectively and professionally through emails, relaying messages, printing documents from various
electronic applications, and running daily reports.
20%
• Accurately processes and documents incoming and outgoing communication in all forms in the hospital EMR or
payer-specific web-based systems. Communicates time-sensitive information to UM teammates. Escalates
challenges to leadership as needed. Involves payer-based supervisory staff when warranted.
20%
• Communicates and documents all conversations with internal and external key stakeholders according to
departmental policy and procedure.
 
 
Our client is the one of the largest Healthcare Staffing Provider in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.
 
 
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.
 
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
 
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.
 
Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!