Utilization Management Director jobs in Shawnee, KS

Utilization Management Specialist - AdventHealth Shawnee Mission

All the benefits and perks you need for you and your family:

• Vision, Medical & Dental Benefits from Day One

• Student Loan Repayment Program

• Received Magnet® recognition from the American Nurses Credentialing Center in January 2019

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Monday – Friday

Shift: 40 hours a week; Days

Location: AdventHealth Shawnee Mission

VIRTUAL

The community you’ll be caring for:

At AdventHealth Shawnee Mission, formerly Shawnee Mission Medical Center, you're more than just a number on a chart. You're a whole person, who functions best when physically, emotionally, and spiritually fit. Find whole-person care, dedicated teams and staff, and a wide variety of medical services, all at our hospital in Shawnee Mission, Kansas.

The role you’ll contribute:

The UM Specialist will serve as the first point of escalation for payors requiring assistance in gaining additional or missing information to support authorization. The UM Specialist will be responsible for ensuring procurement of authorization upon admission and discharge as well as, accuracy of authorization information. The UM Specialist will ensure timely escalation of barriers to authorization requiring clinical expertise and assist in coordination of Peer-to-Peer discussions with the payor.

The value you’ll bring to the team:

• Collaborates and communicates with payor via phone, fax or payor portal

• Submits clinical reviews to payors

• Collaborates and communicates with payor via phone, fax or payor portal

• Submits copies of UM activities to payors, as needed

• Assists in coordinating Peer-to-Peer discussions with the payor for Physician Advisors, Attending Physicians and UM RNs

• Assists UM Coordinator in managing central fax (Vyne)/email accounts (Central Repository), as needed

The expertise and experiences you’ll need to succeed:

• High School Grad

• Two (2) years' experience in Patient Access, Revenue Cycle Operations, Pre-Access, or related department