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663 Healthcare Jobs in bismarck, nd

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    Utilization Management Coordinator

    Sanford Health

    Bismarck, ND 58507
    0.7 miles
    Full-time, Part-time

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                          Bismarck, ND 58507
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                            Sanford Health

                            Bismarck, ND 58507
                            0.7 miles
                            Full-time, Part-time

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                              Sanford Health

                              Bismarck, ND 58507
                              0.7 miles
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                                Sanford Health

                                Bismarck, ND 58507
                                0.7 miles
                                Full-time, Part-time

                                  Utilization Management Coordinator

                                  Sanford Health
                                  Bismarck, ND 58507
                                  Full-time, Part-time
                                  Similar jobs pay $21.88 - $29.83
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                                  Job Description

                                  Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

                                  See yourself at Sanford!

                                  Facility: 7th & Broadway Clinic

                                  Location: Bismarck, ND

                                  Shift: 8 Hours - Day Shifts

                                  Job Schedule: Full time

                                  Weekly Hours: 32.00

                                  Job Summary

                                  Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines. Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported. Provide information via multiple sources of technology applications to insurance companies and contracted vendors to assure authorization for patients. May participate in providing assistance in financial aid and/or counseling if applicable.

                                  Accurately recognizes coding principle diagnosis and principle procedures including complicating/comorbid diagnoses for accurate diagnosis-related group (DRG) assignment during hospitalization. Monitors patient hospitalization to ensure prospective payment limit is not exceeded without due notice to the attending physician. May also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance communication, DRG grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission (TJC) required functions and credentialing. Assists medical records coding personnel as needed to correctly identify diagnoses and procedures, and obtains physician documentation as needed. Monitors patient hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required.

                                  Ability to interact on an interpersonal basis with both providers and nursing staff. Demonstrates proficiency with computers, Microsoft applications, and additional designated technology within the department. Will perform multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs of pediatric to geriatric populations.

                                  Qualifications

                                  Appropriate education level required in accordance with licensure.

                                  Seven years of relevant experience, superior communication and interpersonal skills. Minimum one year healthcare or clinical experience required.

                                  Specific background or experience in healthcare reimbursement, insurance industry, and/or authorization experience would be critical to the success in this role and preferred.

                                  Currently holds an unencumbered Licensed Practical Nurse (LPN) license with State Nursing board and/or possess multi-state licensure privileges, or Registered Health Information Technician (RHIT) required. Additionally, coding certifications also acceptable, i.e. Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital (CPC-H), Certified Outpatient Coder (COC), or Certified Ambulance Coder (CAC).

                                  Obtains and subsequently maintains required department specific competencies and certifications.

                                  Sanford is an EEO/AA Employer M/F/Disability/Vet.

                                  If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

                                  Job Function: Care Coordination

                                  Req Number: R-27907

                                  Featured: No

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                                  Posting ID: 571283192Posted: 2020-09-17