<p>Job Description</p> <p>ECU Health</p> <p>About ECU Health Medical Center</p> <p>ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.</p> <p>Position Summary</p> <p>Responsible for providing technical and professional competence in supporting the utilization review process. Demonstrates understanding of utilization review requirements. Utilizes effective communication skills to ensure accurate completion of work. Collaborates effectively with department staff to achieve goals and objectives.</p> <p>Responsibilities</p> <p>Supports the utilization review process with an emphasis on obtaining insurance authorization for hospital care provided.</p> <p>Uses appropriate software to generate and maintain daily worklists.</p> <p>Collaborates to ensure notification has been initiated with third party payors to obtain pre-certifications for all urgent/emergent admissions.</p> <p>Provides necessary clinical documentation to third party payers to obtain authorization for inpatient days.</p> <p>Releases and submits clinical information to third party payers.</p> <p>Upon identification of possible denial of continual stay forwards information to appropriate case manager/supervisor.</p> <p>Minimum Requirements</p> <p>Associate degree or higher in Human Services related field required.</p> <p>Bachelor degree preferred.</p> <p>Two years of healthcare related experience is preferred.</p> <p>Experience in case management, doctor's office, home health agency, DME agency, or health care field is strongly preferred.</p> <p>Knowledge of medical terminology and basic computer skills are required. Intermediate MS Word and Excel skills preferred.</p> <p>Other Information</p> <p>Monday-Friday role, with day hours specified and possible weekends. This is a supplemental role with the potential for 1-3 days/8hr shifts per week.</p> <p>General Statement</p> <p>It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.</p> <p>Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.</p> <p>We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.</p> <p>Share:</p>