Utilization Management Assistant

Creating Life Better Here starts with you. At San Juan Regional Medical Center, we're more than a healthcare provider—we're a values-driven organization dedicated to delivering exceptional care. As a team member, you help fulfill our mission to make life better here for our community.
The Utilization Management (UM) Assistant is entrusted to provide excellent service and set a positive tone for every customer while serving as the liaison between the Utilization Management Team and payors. This role involves authorizations, compiling denial and appeal documentation, tracking, and monitoring concurrent and retrospective denials, and assisting with peer-to-peer conversations for denial mitigation.
Required Behaviors:
As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values. These values are our culture, our identity as an organization. Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability and Creative Vitality ask more of us than merely completing some list of tasks. Our values ask for a deeper level of commitment, and what is asked of us we freely give because we believe in our mission.
Required Qualifications:
High School diploma or equivalent
Five (5) years’ experience in healthcare and or insurance
Strong communication skills
Excellent customer service skills and phone etiquette
Ability to function autonomously
Experienced in computer programs including Excel and Office
Ability to set and maintain priorities when dealing with multiple demands and interruptions.
Knowledge of insurance and billing requirements
Preferred Qualifications:
Medical Terminology
Utilization Management experience
Duties and Responsibilities:
Receives clinical denials through phone calls, fax and EMR
Documents inpatient authorizations and payor communication
Provides initial and concurrent clinicals to payors through EMR and payor portals
Maintains denial and appeal work ques for the UM team
Reviews and compiles denial and appeal documentation and submits in a timely manner
Tracking and monitoring concurrent and retrospective denials
Assists with coordination of peer-to-peer conversations for denial mitigation
Coordinates W2 meetings and completes provider correspondence
Exhibits effective communication
Performs related duties and responsibilities as required.
All SJRMC Employees are responsible for implementing SJRMC’s Service Standards into their activities: Safety, Courtesy, Effectiveness, and Stewardship
Other duties as assigned
Physical Demands and Environmental Work Conditions:
Prolonged sitting/standing/walking
Fast paced environment
High level of activity
Possible exposure to communicable disease
Repetitive motion (i.e., keyboard usage)
Sensory Requirements:
Must be able to see with corrective eyewear
Must be able to hear clearly with assistance