Utilization Management Specialist (MSW) - Work from Home
Company: Geisinger Health System
Location: Leck Kill
Posted on: September 25, 2022
Job Title: Utilization Management Specialist (MSW) - Work from
Location: Danville, Pennsylvania
Job Category: Wellbeing Services, Geisinger Health Plan
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
- Creates plan for care across the continuum, integrating
member/patient and family preferences and values.
- Monitors patient care through assessments, evaluations and
- 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
- 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
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
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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