UM Coordinator - Utilization Management

Penn State Health - Hershey Medical Center

Location: US:PA: Hershey

Work Type: Part Time

FTE: 0.50

Shift: Day

Hours: 8:00a - 4:30p

Recruiter Contact: Denisse M. Rosado at [email protected] (MAILTO://[email protected])

SUMMARY OF POSITION:

Under the direction of a Utilization Management Nurse or Specialist, the Utilization Management Coordinator supports the UM process by obtaining authorizations, reviewing clinical documentation in the EMR, and ensuring compliance with insurance payer requirements for reimbursement. This role requires a thorough understanding of health plan insurance criteria. Additionally, the coordinator must have clinical knowledge to assess diagnoses, current conditions, and previous treatments relevant to service approvals.

MINIMUM QUALIFICATION(S):

• High School Diploma or equivalent required.

• Experience in a healthcare setting, with familiarity in insurance processes, prior authorizations, and electronic medical records.

• Working knowledge of medical terminology, diagnoses, and treatments relevant to patient care.

• Proven ability to communicate effectively with insurance companies and other external stakeholders.

PREFERRED QUALIFICATION(S):

• Certified Medical Assistant (MA) or Licensed Practical Nurse (LPN)

WHY PENN STATE HEALTH?

Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.

Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:

• Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton).

• Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave.

• Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection.

• Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program.

• Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling.

WHY PENN STATE HEALTH MILTON HERSHEY MEDICAL CENTER?

Penn State Hershey Medical Center is Central Pennsylvania's only Academic Medical Center, Level 1 Regional Adult and Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital, Hershey Medical Center values the hard work and dedication that our employees exhibit every day. Through our core values of Respect, Integrity, Teamwork, and Excellence, our employees are a team committed to compassionate care for our diverse patient population, our community and each other. As a valued team member, we promote continued professional development, specialty certification, continuing education, and career growth.

YOU TAKE CARE OF THEM. WE'LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence - that's Penn State Health. But what makes our healthcare award-winning? That's all you.

This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.

Penn State Health is an Equal Opportunity Employer and does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health's policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.

Union: Non Bargained

Position UM Coordinator - Utilization Management

Location US:PA: Hershey | Clerical and Administrative | Part Time

Req ID 85895