1101 Vermont Ave NW Suite 1200 Washington, DC 20005
Kids Are Our Everything.
Department
10522 HSCSN - Utilization Management
Pay Range
$19.65 - $32.75
Works under the direction of the Director of Utilization Management and UM Review staff. Provides support to UM Reviewers by: managing the UM Department's main phone line and transfers calls to appropriate staff as indicated, opening UM cases by creating authorization shells in the HSCSN electronic Record, sending requests for review to the appropriate UM reviewer based on service being requested and attaching documents related to UM activities to the HSCSN electronic record.
Minimum Education
High School Diploma or GED (Required) Associate's Degree (Preferred)
Minimum Work Experience
2 years related experience in managed care. (Preferred)
Required Skills/Knowledge
Knowledge of medical terminology. Demonstrated skills and ability to work collaboratively in a team environment. Strong written and oral communication skills. Strong organizational skills. Computer literate in Microsoft suite.
Required Licenses and Certifications
Driver's License (Preferred)
Job Functions
Essential job duties:
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Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing.
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Monitors fax machines, faxes queues, and mail for authorization/reauthorization requests and routes information timely to the appropriate individuals for processes.
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Receives calls from enrollees and providers, assesses nature of call and completes requests.
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Answers inquiries from enrollees/caregivers and providers, and routes to appropriate review nurse or Chief Medical Officer.
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Assist clinical staff identifying and securing vendors for services requiring prior authorization (home health, supplies, durable medical equipment, etc.).
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Enters authorizations and/or provides service authorizations to vendors as requested by clinical staff.
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Communicate authorization information to vendors timely and accurately.
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Documents all relevant information and communication, links documents or other information in the HSCSN IT system.
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Seeks advice from UM Director or other designated person(s) with expertise in specialty areas when necessary.
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Effectively resolves inquires related to status of authorization requests.
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Provides accurate and timely documentation to care management staff in the IT system.
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Identifies and seeks guidance for potential risks and utilization concerns.
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Demonstrates compliance with authorization timeliness and case closure.
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Documents according to policy as it related to authorization process.
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Researches and answers provider and vendor authorization inquiries.
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Demonstrates customer service, evidenced by no reports of complaints, or non-responses to e-mails or phone calls.
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Demonstrates compliance with work flow and department processes.
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Demonstrates customer service, and phone etiquette.
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Demonstrates time and attendance.
Other job duties:
- May perform other duties in addition to those outlined in this job description.
The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children’s National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.
Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.
Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.
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