Utilization Management Specialist Job Listing at MedStar Health in Washington, DC (Job ID 145993)

Description

About the Job

General Summary of Position

MedStar Health is looking for a Utilization Management Specialist to join our team at MedStar Georgetown University Hospital!

Supports the UM Team and assists with payor management by liaising between the UR team and payor, IT component to this role; Liaise with third party UM or reimbursement vendors (where applicable)

MedStar Health is a great place to work and grow your career. We provide a supportive and inclusive work environment, comprehensive health and wellness benefits, generous PTO, tuition assistance, retirement plans, and many other benefits focused on your wellbeing. Apply today and learn how MedStar Health can be your next great career move!  

Primary Duties:  

• Coordinates daily insurance logs for hospital inpatients and observation cases, ensuring compliance with department policies, procedures, and accreditation standards.
• Manages authorizations, denials, and appeals by collaborating with Patient Financial Services, Medical Records, and Admitting; enters and tracks data in the Case Management program.
• Communicates effectively with payors to obtain and maintain authorizations for appropriate levels of care and length of stay, partnering with UR clinical staff for support.
• Maintains and reports denial management data, preparing trend analyses and reports to support the Denials Management Team and performance improvement initiatives.
• Provides administrative and analytical support by maintaining databases, assisting with appeal documentation, and participating in multidisciplinary teams to improve utilization and outcomes.

Qualifications: 

• High School Diploma or Equivalent (Required)
• Bachelor's degree in business or healthcare field (Preferred)
• 1 year healthcare Experience (Required)
• Experience in physician billing/coding or data extraction/reporting (Preferred)