Organization: ABSMC-Alta Bates Herrick Campus
Position Overview: Accumulates, interprets, and documents timely information to justify acute hospital admission, need for continued stay, and proper utilization of physician, nursing, and ancillary services. Responsible for concurrent review on specific patients. Develops, coordinates and monitors systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with hospital administration, medical staff, patient registration and representatives of review organizations and others to ensure effective utilization of services and appropriate service reimbursement. Monitors and acts as a liaison between external payers, internal business office, admissions staff, and clerical unit staff to assure that quality care is delivered at the appropriate level of service and that documentation of care meets appropriate standards. Interfaces with hospital administration and unit medical doctors and provides data related to the current management of resources. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety while delivering optimal patient care.
Job Description:
These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).
JOB ACCOUNTABILITIES:
CASE MANAGEMENT:
CLERICAL:
SAFETY:
COMPLIANCE:
EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma. Bachelor's: Business Administration or related field.
DEPARTMENT REQUIRED EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma. Department, Behavioral Health: Master’s in Social Work or related field.
SKILLS AND KNOWLEDGE:
PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements
Job Shift: Days
Schedule: Per Diem/Casual
Shift Hours: 8
Days of the Week: Variable
Weekend Requirements: As Needed
Benefits: No
Unions: No
Position Status: Non-Exempt
Weekly Hours: 0
Employee Status: Per Diem/Casual
Number of Openings: 1
Sutter Health is an equal opportunity employer. EOE/M/F/Disability/Veterans.
Pay Range: $46.29 to $69.44 / hour
The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.
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