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Inpatient Utilization Management Specialist
Ref No.: 18-13214
Location: Charlestown, Massachusetts
Position Type:Contract
Start Date / End Date: 10/22/2018 to 01/18/2019
Duration: 3 + Months
Location: Charlestown, MA 02109

Qualifications: Education Required:
• Associate's degree in Healthcare, Nursing, Social Work or a related area or equivalent relevant work experience is required Experience Required:
• 2 years of office experience, specifically in either a high volume data entry office, customer service call center, or health care office administration department. Preferred/Desirable:
• Experience with FACETS or other healthcare database.
• Experience with Health Plan Utilization / Claims departments.
• Prior customer service experience.
• Bilingual skills, fluency in Spanish. Certification or Conditions of Employment:
• Pre-employment background check. Competencies, Skills, and Attributes:
• Bi-lingual preferred. • Strong customer service skills and diplomacy skills.
• Strong oral, listening, interviewing, interpersonal, written, and verbal communication skills; the ability to interact and work successfully with internal and external colleagues. • Ability to effectively prioritize and manage multiple tasks in a fast-paced environment.
• Ability to prioritize work when processing referrals and authorization requests per guidelines and within specific Turn Around Timeframes.
• Ability to process high volumes of requests with a 95% or greater accuracy rate.
• Competency with standard Microsoft Office applications, particularly MS Outlook and MS Word, and other data entry processing applications. Working Conditions and Physical Effort: • Regular and reliable attendance is an essential function of the position.
• Fast paced, call center environment
• Ability to work OT if required
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

Job Summary: Functions as a team member working telephonically in collaboration with the Inpatient Utilization Management Clinician to ensure receipt of clinical information and appropriate discharge planning. Key Functions/Responsibilities:
• Screens all inpatient admissions to determine what needs to be referred to Inpatient Utilization Management Clinician
• Requests clinical information from facilities according to workflow (SPAD/POC) and updates authorization in documentation system per workflow, sending letters as appropriate.
• Ensures that reminder is sent to Clinician for review on the appropriate day.
• Refer for RC2 Upgrade and High Cost referrals as appropriate or as directed Clinician
• Refer to CM any member that meets the established guidelines as directed by Clinician
• Requests discharge dates from facilities according to workflow • Track and report to Public Partnerships Mass Health members in long term care according to Mass Health guidelines.
• Initiate discharge planning for specific diagnoses/conditions per workflow. Supervision Exercised:
• None Supervision Received:
• Direct supervision is received weekly.