Align yourself with an organization that has a reputation for excellence! Cedars Sinai received the National Research Corporation's Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also received the Advisory Board Company's Workplace of the Year. This award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us, and discover why U.S. News & World Report has named us one of America's Best Hospitals!
What You Will Do in This Role:
The Utilization Review Case Management Assistant prioritizes and manages multiple demands in a fast-paced environment. As assigned, provides support to UR Case Management staff. Maintains effective communication between the case management team, care providers, patients, families, payers and external vendors. The UR Case Management Assistant is also responsible for documenting all interventions appropriately and accurately in the EPIC/CS-Link system and other systems as required. Participates in the coordination and implementation of department support processes through critical thinking, teamwork, and communication.
Utilizes and maintains working knowledge of insurance terms, guidelines and has familiarity with payer processes for initiating authorizations.
Interprets and communicates payor requirements and requests to the appropriate staff.
Actively participates in team workflows, initiates, problem solves and accepts responsibility in maintaining relationships that are equally respectful to all.
Communicates effectively with all Partners, such as RN case managers, physicians, insurance carriers, designated intermediaries, and/or vendors/agencies to ensure that patient information is current, accurate, and complete.
Contributes to the achievement of the Utilization Management Department goals through effective participation in department committees and informal work groups. Provides timely and continual coverage of assigned work area in order to ensure all accounts are completed.
Provides guidance to other members of assigned team regarding opportunities to improve processes.
May provide and/or maintain data and spreadsheets for leadership. Assists with tracking and/or trending data as needed.
Maintains up-to-date concurrent authorizations for in-house patients.
Coordinates the administrative aspects of the utilization review process involving authorizations, requests for clinical reviews, concurrent denial documents, messages received from payors and identify issues needing further resolution. Determine appropriate UR RN reviewer and refer for handling if necessary.
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.