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Utilization Management Specialist (MSW) - Work from Home

Company: Geisinger Health System
Location: Leck Kill
Posted on: September 25, 2022

Job Description:

Job Title: Utilization Management Specialist (MSW) - Work from Home
Location: Danville, Pennsylvania
Job Category: Wellbeing Services, Geisinger Health Plan
Schedule: Days
Work Type: Full time
Department: GHP Medical Management Division
Date Posted: 09/09/2022
Job ID: R-37729
Job Summary Assesses and manages admitted members or patients. Assures delivery of comprehensive, cost-effective, quality care, as well as appropriate allocation of medical resources. Assesses, plans, implements, coordinates, monitors and evaluates all options and services to assure safe transitions of care that will support best outcomes for patients and their families. Assesses for accuracy in the assignment of patient status to reflect congruence with clinical condition, physical intent and utilization review outcomes.
Job Duties

  • Creates plan for care across the continuum, integrating member/patient and family preferences and values.
  • Monitors patient care through assessments, evaluations and records.
  • Advocates for resources and removal of barriers.
  • Performs prior authorizations and pre-certifications.
  • Actively engages with facility staff to assure adequate, appropriate and timely discharge planning.
  • Explores and coordinates alternatives to the requested level of care and communicates options to attending physician and facility staff.
  • Explains benefits, assist with discharge planning, provides notification of denial of coverage with explanation of Peer to Peer and/or Appeal Rights.
  • Identifies and documents information required for reporting needs, compliance with external regulators, support of Quality initiatives, and appropriate adjudication of claims.
  • Participates in the development or revision of programs to reduce admissions for acute and chronic conditions and assist with decreasing inpatient length of stays as well as assuring appropriate utilization of benefits.
  • Assists with the management of Members or patients admitted to non-participating facilities or seeking care with non-participating vendors/agencies.
    Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position. Position Details *Geisinger offers a comprehensive suite of healthcare benefits all starting day one of employment! This includes medical, prescription drug, vision and dental coverage. We also offer up to $5,000 tuition reimbursement and 5% contribution to your retirement plan. Education Master's Degree-Social Work (Required)
    Experience Minimum of 3 years-Related work experience (Required)
    Certification(s) and License(s) Licensed Social Worker within 1 year - Default Issuing Body
    Our Purpose & Values OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

Keywords: Geisinger Health System, Reading , Utilization Management Specialist (MSW) - Work from Home, Executive , Leck Kill, Pennsylvania

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