Talent.com
Utilization Review Educator

Utilization Review Educator

Beacon Health SystemGranger, Indiana, United States, 46530
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Utilization Review Educator

Reports to the Manager / Utilization Review and Case Management. Is responsible for assessing, planning, coordinating and evaluating orientation, continuing education and in-service programs for staff which are competency based. Recommends improvements in the quality of utilization review practice and standards. Serves as a resource to staff. Assists with steps to resolve preventable denials and coordinates with the Manager to identify and correct weaknesses in the revenue cycle process that can mitigate future denials.

MISSION, VALUES and SERVICE GOALS

  • MISSION : We deliver outstanding care, inspire health, and connect with heart.
  • VALUES : Trust. Respect. Integrity. Compassion.
  • SERVICE GOALS : Personally connect. Keep everyone informed. Be on their team.

Orientation of New Hires

  • Develops curriculum and keeps current new hire orientation for all positions affecting UR at both hospitals and any other positions associated with UR Departments.
  • Develops schedules, teaching methods, evaluation tools, preceptor development programs, and coordinates for all parties a smooth onboarding and training process.
  • Works with manager to assure performance progress is documented and feedback whether positive or corrective for timely movement through orientation phase.

    • Continuing Education and Competency Validation

  • Assess learning needs of UR associates and develops plan, goals, and validates with management and associates.
  • Assures competency assessment of staff working in UR Process through audits, direct observations / discussions, and individual education plans as needed.
  • Responsible for all staff development activities around upgrades to UR tools, criteria sets, and other mechanisms / processes needed in UR process.
  • Assists as a resource regarding UR situations of concern and decision making.
  • Keeps records of all education and competency validation activities.

    • Project Management

  • Leads or participates in strategic initiatives in the revenue cycle where utilization review plays a role and communicates relevant information to other departments
  • Supports management communications and actions to assure effective change management culture in departments.

    • Performance / Process Improvement / Efficiency

  • Evaluates work processes, identifies inefficiencies, lack of standardization, and opportunities for improvement.
  • Collects information through data collection, observations, surveys, interviews, etc., to analyze the process.
  • Develops metrics for success and collaborative approach to design improvement.
  • Implements PDCA and LEAN tools as indicated to refine, measure, revise, and sustain improved processes in UR.
  • Monitors select measures for oversight committees and prepares timely reports.

    • ORGANIZATIONAL RESPONSIBILITIES

    Associate complies with the following organizational requirements :

  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established timeframes.
  • Completes annual employee health requirements within established timeframes.
  • Maintains license / certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position / department.
  • Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
  • Adheres to regulatory agency requirements, survey process and compliance.
  • Complies with established organization and department policies.
  • Available to work overtime in addition to working additional or other shifts and schedules when required.

    • Commitment to Beacon's six-point Operating System, referred to as The Beacon Way :

  • Leverage innovation everywhere.
  • Cultivate human talent.
  • Embrace performance improvement.
  • Build greatness through accountability.
  • Use information to improve and advance.
  • Communicate clearly and continuously.

    • Education and Experience

  • The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Bachelor of Science in Nursing degree and current license to practice as a Registered Nurse in Indiana. A Master's degree in Nursing or advanced degree is preferred. Two years of recent utilization review / case management experience is required.

    • Knowledge & Skills

  • Demonstrates comprehensive knowledge of current training and adult education philosophies, techniques, programs, tools and equipment.
  • Demonstrates comprehensive knowledge of and competency in performing utilization review / case management functions.
  • Demonstrates critical thinking and analytical skills necessary to conduct training needs analysis, design programs, identify variances in standards of care.
  • Demonstrates ability to teach staff with a variety of educational backgrounds.
  • Demonstrates leadership skills necessary to coordinate activities and motivate all levels of staff.
  • Demonstrates initiative and high interest in teaching others.
  • Demonstrates well-developed interpersonal skills necessary to interface effectively with all levels of staff and customers and to conduct group and individual instruction.
  • Demonstrates well-developed communication skills, both verbal and written, necessary to communicate in an articulate and effective manner in front of groups. Relates to and provides effective feedback to the learner in a manner that is patient, constructive and enhances self-esteem.
  • Requires fundamental knowledge of the revenue cycle process, which includes such things as patient access, utilization review, charge capture, HIM and patient accounting.

    • Working Conditions

  • Works in a fast-paced environment requiring frequent changes in job demands.
  • May be exposed to bio-hazards.
  • Skillful in use of information technology including Excel, PowerPoint, Word and software tools.

    • Physical Demands

  • Requires the physical ability and stamina to perform the essential functions of the position.

    • PIf2544de7f19d-30511-38302547

    serp_jobs.job_alerts.create_a_job

    Utilization Review • Granger, Indiana, United States, 46530

    Job_description.internal_linking.related_jobs
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Licensed Subject Matter Expert

    Licensed Subject Matter Expert

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Subject Matter Expert (SME).Key Responsibilities : Collaborate with cross-functional teams to support program execution and strategic growth Lead curriculum development...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    LMS Training Assistant

    LMS Training Assistant

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for an LMS Training Assistant.Key Responsibilities : Oversee the department Service Desk, managing service request tickets related to LMS issues and updating user learning pla...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Senior Enrollment Analyst

    Senior Enrollment Analyst

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Senior Enrollment Analyst to join their strategic team.Key Responsibilities Analyze data sets to evaluate trends and forecast enrollment probabilities Create presentat...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    Learning Platforms Administrator

    Learning Platforms Administrator

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Learning & Development Administrator.Key Responsibilities Provide technical support for learning platform users and maintain accurate user records Pull and analyze usa...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Special Education Teacher

    Special Education Teacher

    Schoolforce Solutions IncMishawaka, IN, US
    serp_jobs.job_card.permanent
    We are looking for two talented.One position will be working with middle school age children and the other will be working with elementary age children. Responsibilities would include : .Develop and i...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    California Licensed Provider Enrollment Specialist

    California Licensed Provider Enrollment Specialist

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Provider Enrollment Specialist to coordinate health insurance network participation for medical providers. Key Responsibilities Complete provider payer enrollment and re...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Senior Provider Enrollment Specialist

    Senior Provider Enrollment Specialist

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Senior Provider Enrollment Specialist, Fully Remote.Key Responsibilities : Manage the provider enrollment process and serve as the point of contact for client-related qu...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    North Carolina Eligibility Team Lead

    North Carolina Eligibility Team Lead

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Food & Nutrition Services - Eligibility Team Lead (Hybrid).Key Responsibilities : Provide day-to-day support to eligibility staff and assist caseworkers with complex pol...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Remote Coding Educator

    Remote Coding Educator

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    A company is looking for a Coding Educator Remote.Key Responsibilities Audit all services and payers Required Qualifications AA Degree required. Bachelor's degree preferred 5 years of coding ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Seasonal Eligibility Research Representative

    Seasonal Eligibility Research Representative

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for an Eligibility Research Rep I (Seasonal - Remote, $15 / hr).Key Responsibilities Research and resolve member eligibility requests while maintaining production and accuracy ...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    Healthcare Credentialing Coordinator

    Healthcare Credentialing Coordinator

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Healthcare Credentialing Coordinator, part-time and remote.Key Responsibilities Manage the credentialing and re-credentialing process for healthcare providers, ensuring...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Manager of Enrollment Operations

    Manager of Enrollment Operations

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Manager, Enrollment Operations (Facets Required).Key Responsibilities Lead the Enrollment team to ensure departmental goals and standards are met Oversee financial and...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    PowerSchool Registrar New York & Washington

    PowerSchool Registrar New York & Washington

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a PowerSchool Registrar (Remote).Key Responsibilities Audit attendance and enrollment coding entered by on-site staff regularly Identify, document, and correct data qual...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_less
    • serp_jobs.job_card.promoted
    Qualified Intellectual Disabilities Professional (QIDP)

    Qualified Intellectual Disabilities Professional (QIDP)

    Benchmark Human ServicesSouth Bend, IN, United States
    serp_jobs.job_card.full_time
    Benchmark Human Services has grown to become one of the most respected organizations in the country in the areas of intellectual and developmentally disabilities (IDD) and behavioral health.We work...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_30
    • serp_jobs.job_card.promoted
    Curriculum Developer - Healthcare

    Curriculum Developer - Healthcare

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Curriculum Developer - Healthcare Generalist.Key Responsibilities Develop high-quality, engaging online learning content for various healthcare programs Ensure alignme...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_1_day
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Graduate Student Coordinator

    Graduate Student Coordinator

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Graduate Student Coordinator III.Key Responsibilities Provide individualized academic and personal support to approximately 225 Hybrid Pathway Doctor of Physical Therap...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Kentucky Licensed Social Work Professor

    Kentucky Licensed Social Work Professor

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for an Assistant Professor for the Bachelor of Social Work (BSW) Program.Key Responsibilities Teach undergraduate Social Work courses Advise and mentor BSW students in acade...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Bilingual Family Interviewer

    Bilingual Family Interviewer

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a Family Interviewer- Bilingual Spanish or Mandarin (Per-Diem).Key Responsibilities Conduct thorough interviews of applicants (youth ages 7-16) and their parents or guard...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    DTC Retention Strategist

    DTC Retention Strategist

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for a DTC Retention Manager / Account Strategist (using Klaviyo).Key Responsibilities Serve as the main strategic point of contact for 15+ retained brands and lead client cal...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours
    • serp_jobs.job_card.promoted
    • serp_jobs.job_card.new
    Psychology Professor

    Psychology Professor

    VirtualVocationsSouth Bend, Indiana, United States
    serp_jobs.job_card.full_time
    A company is looking for an Assistant or Associate Professor of Psychology.Key Responsibilities Teach online undergraduate psychology courses in various topics Develop and deliver high-quality i...serp_jobs.internal_linking.show_moreserp_jobs.last_updated.last_updated_variable_hours