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Utilization Review Clinical Specialist (Remote)
Recruited by CHS Corporate 9 months ago
Address , Franklin, 37067
Medicaid Utilization Review Analyst
Company | State of Idaho Employment |
Address | Greater Idaho Falls, United States |
Employment type | FULL_TIME |
Salary | |
Category | Human Resources Services |
Expires | 2023-09-04 |
Posted at | 9 months ago |
Posting Begin Date: 08/02/2023
- THIS ANNOUNCEMENT WILL BE OPEN UNTIL FILLED. APPLICANTS ARE ENCOURAGED TO APPLY AS SOON AS POSSIBLE TO BE CONSIDERED.
- An opportunity for student loan forgiveness (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service)
- Multiple savings plans, optional 401K, and optional 457
- Generous vacation and sick leave accrual beginning as soon as you start
- Ongoing training opportunities
- Paid parental leave
- And more!
- Basic life insurance for employee and family (employee covered at one times annual salary; spouse covered at $10,000; child covered at $5,000)
- Wellness programs
- Excellent medical, dental and vision (https://ogi.idaho.gov/benefits-plans/) insurance- (full-time) employee only coverage for PPO $65/month for medical and vision & $11.00/month for dental
- 11 paid holidays a year
- Meets with providers to discuss findings.
- Reviews and analyzes Medicaid Management Information System (MMIS) reports to identify utilization patterns and individual providers or clients who may be abusing the program.
- Develops cases by interviewing providers and clients, conducts on-site reviews, and documents evidence.
- Confers with professional medical consultants concerning appropriateness and quality of medical goods and services provided to clients.
- Recommends and participates in development and implementation of policies and procedures for monitoring program utilization.
- Makes and assists with presentations to internal units, provider groups, and Medicaid staff on Utilization Review policy and procedures.
- Common medical payment procedural codes used in Current Procedural Terminology Fourth Edition (CPT-4), and other nationally recognized coding references.
- Medical terminology.
- Medical diagnostic and procedural terms.
- Data processing systems as used in program monitoring and management information processes. Typically requires completion of coursework/training regarding data processing systems and their use OR at least six months of work experience working with the above type data processing systems.
- Recognizing patterns of medical assistance billing that suggest fraud, abuse, over-utilization, child abuse, and claims processing problems. Typically requires at least six months of work experience in a medical or insurance office with responsibility for reviewing or processing claims that included recognizing problems such as: patterns of abuse; fraud; incomplete information; improper coding, etc.
- Conducting interviews to obtain facts for cases. Typically requires at least six months of work experience conducting interviews for investigations to solicit facts, record information, and determine eligibility or an appropriate course of action based on findings. Types of qualifying experience could include a background in credit collection, law enforcement, financial institutions, or social service programs or services. Experience as an office/administrative support staff conducting informal day-to-day interviews is not in-depth enough to qualify. Experience conducting employment interviews is typically non-qualifying. Experience being interviewed, e.g. to obtain employment, does not qualify.
- Compiling, analyzing, and interpreting statistical data, and developing recommendations. Typically requires successful completion of coursework and/or training covering statistics AND at least six months of work experience that required both verbal and written communications of findings to both internal and external entities OR at least one year of work experience that required both verbal and written communications of findings to both internal and external entities.
- Providing verbal and written communication of findings to both internal and external entities. Typically requires successful completion of coursework and/or training covering statistics AND at least six months of work experience that required both verbal and written communications of findings to both internal and external entities OR at least one year of work experience that required both verbal and written communications of findings to both internal and external entities.
- PLEASE NOTE: application assistance is not available after the business hours listed below, on the weekends, or on holidays and you must apply before 11:59 pm on the closing date. When applying, use CHROME as your browser to avoid complications.
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