Utilization Review Assistant PRN

Sinai Hospital's Utilization Review operates as a distinct specialty service line of physician advisors, nurses, and support staff who ensure hospital stays are clinically appropriate and fully covered by the patient's insurance. The team focuses on appropriate resource use, operational efficiency, and timely patient services while maintaining or improving quality of care.

JOB SUMMARY: The Utilization Review Assistant is responsible for performing administrative and operational functions needed for the Utilization Review Department of Care Management and ensures excellent communication with third party payors and internal revenue cycle partners.

This position is a primarily remote position and will come onsite to cover Admin Asst. when off.

RESPONSIBILITIES: Efficiently and effectively assists with the daily operations for the Utilization Review functions of Sinai Hospital of Baltimore. Communicates relevant information effectively to healthcare team, third party payers and internal revenue cycle partners. Manages payor calls and facilitates communication between payors and UR nurses. Faxes clinical reviews and updates to insurance companies when needed. Maintains, updates, and files insurance lists. Maintains logs for insurance, denials and appeals. Maintains Utilization and Appeals filing system. Accesses online payor portals for authorizations and denials and letters. Completes Livanta appeals. Receive Notice of Eligibility and logs information. Upload clinical information to Telligen/ Qualitrac. Performs data system entry and reporting daily. Back-up to the Care Management Administrative Assistant the following duties will be assigned: Organizes day to day departmental functions and acts as a care management departmental resource. Notifies leadership of operational problems. Maintains copies of letters sent to the patient and physicians in the Care Management Drive.

REQUIREMENTS:

Formal working knowledge: equivalent to an Associate's degree (2 years college) preferred

1-3 years of administrative experience required

Patient registration experience is strongly preferred

Must Live in One of the Following Districts/States: District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia

Pay Range: $17.00 to $24.75 Based On Experience

About Sinai Hospital

Sinai Hospital of Baltimore is a nationally recognized academic medical center, a designated Level II Trauma Center, and the largest community hospital in Maryland. As part of LifeBridge Health - one of the region's most comprehensive healthcare systems - Sinai delivers advanced care with a mission to improve the health of the communities we serve, and to take care of the people who take care of patients.