Utilization Management Coordinator PRN Days - Coverage 7 days per week as needed

Why UT Southwestern? With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the #1 hospital in Dallas-Fort Worth for the sixth consecutive year, we invite you to continue your healthcare career with us at William P. Clements Jr. University Hospital. You'll discover a culture of teamwork, professionalism, and consistent opportunities for learning and advancement into leadership roles.

Performs EPIC functions to assist the UM department with payor communications. Assist in faxing documents to insurance companies. Manages phones and fax lines. Generates EPIC reports specific to third party payors. Assist with insurance company notification of admission process.

Experience and Education

• High school graduate is required. Some college preferred.
• 5 years of hospital and/or insurance industry experience is required.
• Knowledge of Health Insurance mechanisms and coverage is required.
• Proficient in Microsoft Office Suite Working knowledge of EPIC is preferred

Job Duties

• Assists in faxing initial, concurrent or discharge reviews to insurance companies.
• Documents information submitted/received by phone or fax from insurance companies into Epic.
• Manages phone and fax lines. Processes incoming faxes, scans documents and other clerical duties as deemed necessary to assist with the facilitation of Utilization Management functions.
• Communicates with insurance company to obtain pending authorizations. • Responds to insurance requests for clinical reviews within time frames designated by contractual obligations.
• Generates and submits EPIC reports specific to third party payers.
• Maintains departmental productivity, quality metrics and completes assigned tasks in compliance with regulatory and departmental requirements.
• Performs other duties as assigned.

Knowledge, Skills, & Abilities

• Knowledge of health insurance mechanisms and coverage
• Knowledge of UR process including admission status and continued stay reviews
• Proficient in Microsoft Office Suite, including Word, Excel, PowerPoint and Power BI
• Strong oral and written communication skills
• Demonstrated accuracy skills

Working Conditions

This job is remote only and individuals who reside in the job will permanently work 100% from an alternate approved worksite. Any qualifications to be considered as equivalents in lieu of stated minimums require prior approval of the Vice President for Human Resources Administration, or his/her designee.

To learn more about the benefits UT Southwestern offers, visit https://www.utsouthwestern.edu/employees/hr-resources/

This position is security-sensitive and subject to Texas Education Code •51.215, which authorizes UT Southwestern to obtain criminal history record information.

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.