Back to Jobs search

System Utilization Management SUM Specialist

Alameda Health System • Oakland, CA • 2w ago

Oakland, CA

Highland General Hospital

SYS Utilization Management

Full Time - Day

Care Management

Req #:41828-30985

FTE:1

Posted:Today

Summary

SUMMARY: The System Utilization Management Specialist (UMS) will play a pivotal role in supporting the Utilization Management (UM) team across all three AHS campuses. The UMS will report directly to the UM Manager. This multifaceted position will focus on both clinical and administrative functions within the UM department, ensuring seamless operations and effective management of utilization processes **.

DUTIES & ESSENTIAL JOB FUNCTIONS:** NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

Payer Liaison: Serve as the primary point of contact for all insurance-related inquiries and interactions. Facilitate clear and accurate communication between the UM department and payers, addressing issues, sending clinical information, and ensuring timely processing and receipt of Inpatient authorizations and/or denials.

Fax Management:

Check all UM fax folders daily to ensure timely receipt and sending of documents.

Ensure that clinical documentation is faxed to and received by all payers to support inpatient admissions and/or denials.

Maintain accurate records of all fax communications.

Optum Portal Management: Check Optum Portal frequently throughout the day to ensure that all determinations are addressed and uploaded to the EPIC charts.

Authorization Management:

Obtain initial and concurrent inpatient authorizations from insurance companies for all inpatient admissions.

Track the status of authorization requests and follow up with insurance companies, as needed.

Confirm patient's insurance coverage and benefits, as requested.

Accurately document all communication with insurance companies in EPIC.

Maintain detailed records of authorization requests, approvals and inpatient denials.

Update UR team on the status of authorizations, as required.

Maintains current database of payor contact information.

Data Entry and Reporting: Perform accurate data entry into the EHR, ensuring data integrity.

Multitasking and Prioritization:

Manage multiple tasks and responsibilities effectively in a fast-paced, ever-changing environment.

Prioritize tasks to meet deadlines and support the needs of the department.

Administrative Support:

Provide comprehensive administrative assistance to the Utilization Review (UR) team.

Assist with other duties, as assigned.

Participate in new staff onboarding, as needed.

May have to float throughout the system to different locations.

MINIMUM QUALIFICATIONS :

Required Education : Associate degree is required, OR equivalent years of experience, as typically found in 2-3 years of health education in an inpatient, skilled nursing, home health, health plan or related setting.

Preferred Education : Equivalent experience will be accepted in lieu of the required degree or diploma.

Required Experience : Minimum three (3) years in health care setting working directly with interdisciplinary team/patients/families in a clinical team setting. Hospital and/or Health Plan experience.

Preferred Experience : Experience coordinating benefits, obtaining authorizations, Hospital experience.

Alameda Health System is an equal opportunity employer and does not discriminate against any employee or applicant for employment based on race, color, religion, national origin, age, gender, sex, ancestry, citizenship status, mental or physical disability, genetic information, sexual orientation, veteran status, or military background.

Similar Jobs

Talent Manager

Robert Half • San Francisco, CA • 15min ago

Management & Administrative

Description Our Talent Managers work in a team environment and have responsibility for negotiating and developing business with new and current clients. Talent Managers market our services via telephone, video and by...

15min ago

Go to Apply

Strategic Account Manager II

IBM • San Francisco, CA • 20h ago

Management & Administrative

Introduction A career in IBM Software means you'll be part of a team that transforms our customer's challenges into industry-leading solutions. We are an infinitely curious team, always seeking new possibilities, and...

20h ago

Go to Apply

Apptio Cloudability Senior Technical Account Manager (TAM)

IBM • San Francisco, CA • 20h ago

Management & Administrative

Introduction Your Role and Responsibilities Each Cloud TAM manages a portfolio of customers with a focus on optimizing their current capabilities and expanding their use cases by providing them with deep technical m...

20h ago

Go to Apply

Senior Manager, Science, Uber Eats Growth

Uber • San Francisco, CA • 20h ago

Management & Administrative

About the Role UberEats is on a mission to redefine how people discover and enjoy food - and the Growth team is at the heart of that journey. We incubate and scale new tactics for acquiring, engaging, and retaining us...

20h ago

Go to Apply

Field Account Manager, Redi Carpet

HD Supply • Hayward, CA • 20h ago

Management & Administrative

Preferred Qualifications Bachelor's degree in business administration or a related field. Business-to-Business sales experience including experience using various sales techniques such as Consultative or Solution Ba...

20h ago

Go to Apply

Customer Service Supervisor

Adecco US, Inc. • San Leandro, CA • 1d ago

Management & Administrative

Customer Service Supervisor - Full Time Salary: $55,240.00-$62,400 DOE plus Benefits and $200 bonus paid out monthly We're currently seeking a Customer Service Supervisor to join our growing team! If you're energ...

1d ago

Go to Apply

Customer Service Supervisor

Adecco US, Inc. • San Leandro, CA • 1d ago

Management & Administrative

1d ago

Go to Apply

Senior Project Manager

Accenture • San Francisco, CA • 1d ago

Management & Administrative

We are: Accenture Song accelerates growth and value for our clients through sustained customer relevance. Our capabilities span ideation to execution: growth, product and experience design; technology and experience p...

1d ago

Go to Apply

Inventory Specialist

Walgreens • San Francisco, CA • 1d ago

Management & Administrative

Job Description: Responsible for executing, monitoring, and training inventory best practices and standard operating procedures for the entire store, including both front end and pharmacy. Supports pharmacy inventory...

1d ago

Go to Apply

Marketing Consultant IV, Acquisition and Retention Marketing

Kaiser Permanente • Oakland, CA • 2d ago

Management & Administrative

Job Summary: In addition to the responsibilities listed below, this position is responsible for developing and executing multi-channel direct marketing campaigns including production schedule, budget, and metrics to d...

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.