Utilization Management Assoc / Clinical Resource Management

Summary

Hartford HealthCare is a comprehensive healthcare network seeking a Clinical Resource Management Associate to support and coordinate utilization management services. The role manages reports and electronic health record workflows, supports denials and appeals, communicates with payers and internal departments, and performs administrative tasks.

Responsibilities

• Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers
• Monitors and manages assigned EPIC work queues
• Updates EPIC with authorization and denial information
• Provides the Clinical Resource Management Nurse with support for denials, appeals, and physician advisor communication
• Retrieves, manages and/or triages department phone calls, voicemails, fax requests and Tiger Texts
• Communicates with payers, case management, medical records, and other departments
• Scans and uploads documentation into the electronic health records
• Performs routine and administrative tasks within the scope of non-licensed personnel
• Manages Certification Email process
• Other duties as assigned by supervisor

Skills

• High School Diploma
• Two+ years professional work experience in health care, managed care, or insurance
• Strong interpersonal and communication skills
• Effective time management skills, able to work in a fast-paced environment with changing priorities
• Effective organizational skills
• High level understanding of confidentiality and HIPAA requirements
• Medical Administrative Assistant certification

Qualifications

Must Haves

• High School Diploma
• Two+ years professional work experience in health care, managed care, or insurance
• Strong interpersonal and communication skills
• Effective time management skills, able to work in a fast-paced environment with changing priorities
• Effective organizational skills
• High level understanding of confidentiality and HIPAA requirements

Nice to Haves

• Medical Administrative Assistant certification

Benefits

• Career development and growth opportunities
• Competitive benefits program designed to ensure work/life balance
• Service recognition programs