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Cedars-Sinai Case Management Assistant - Utilization Review (Part-Time) in Los Angeles, California

Align yourself with an organization that has a reputation for excellence! Cedars Sinai received the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also received the Advisory Board Company’s Workplace of the Year. This award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us, and discover why U.S. News & World Report has named us one of America’s Best Hospitals!

What You Will Do in This Role:

The Part-Time Utilization Review Case Management Assistant prioritizes and manages multiple demands in a fast-paced environment. As assigned, provides support to UR Case Management staff. Maintains effective communication between the case management team, care providers, patients, families, payers and external vendors. The UR Case Management Assistant is also responsible for documenting all interventions appropriately and accurately in the EPIC/CS-Link system and other systems as required. Participates in the coordination and implementation of department support processes through critical thinking, teamwork, and communication.

Utilizes and maintains working knowledge of insurance terms, guidelines and has familiarity with payer processes for initiating authorizations.

Interprets and communicates payor requirements and requests to the appropriate staff.

Actively participates in team workflows, initiates, problem solves and accepts responsibility in maintaining relationships that are equally respectful to all.

Communicates effectively with all Partners, such as RN case managers, physicians, insurance carriers, designated intermediaries, and/or vendors/agencies to ensure that patient information is current, accurate, and complete.

Contributes to the achievement of the Utilization Management Department goals through effective participation in department committees and informal work groups. Provides timely and continual coverage of assigned work area in order to ensure all accounts are completed.

Provides guidance to other members of assigned team regarding opportunities to improve processes.

May provide and/or maintain data and spreadsheets for leadership. Assists with tracking and/or trending data as needed.

Maintains up-to-date concurrent authorizations for in-house patients.

Coordinates the administrative aspects of the utilization review process involving authorizations, requests for clinical reviews, concurrent denial documents, messages received from payors and identify issues needing further resolution. Determine appropriate UR RN reviewer and refer for handling if necessary.

Requirements:

Education:

High School Diploma or GED required. Associate Degree or College Diploma in Business, Health or a related field preferred.

Experience:

  • Minimum of 1 year's experience hospital in patient registration, commercial insurance/authorization handling, claims processing or utilization review required.

  • Minimum of 1 year's Acute Care experience preferred.

Why work here?

We take pride in hiring the best employees. Our talented staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

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