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Case Management Assistant - Utilization Review

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Requisition # HRC0494863A

Align yourself with an organization that has a reputation for excellence! Cedars Sinai received the National Research Corporation’s Consumer Choice Award 19 years in a row for providing the highest-quality medical care in Los Angeles. We also received the Advisory Board Company’s Workplace of the Year. This award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. Join us, and discover why U.S. News & World Report has named us one of America’s Best Hospitals!

 

What You Will Do in This Role:

The Utilization Review Case Management Assistant prioritizes and manages multiple demands in a fast-paced environment. As assigned, provides support to UR Case Management staff. Maintains effective communication between the case management team, care providers, patients, families, payers and external vendors. The UR Case Management Assistant is also responsible for documenting all interventions appropriately and accurately in the EPIC/CS-Link system and other systems as required. Participates in the coordination and implementation of department support processes through critical thinking, teamwork, and communication.

Utilizes and maintains working knowledge of insurance terms, guidelines and has familiarity with payer processes for initiating authorizations.

Interprets and communicates payor requirements and requests to the appropriate staff.

Actively participates in team workflows, initiates, problem solves and accepts responsibility in maintaining relationships that are equally respectful to all.

Communicates effectively with all Partners, such as RN case managers, physicians, insurance carriers, designated intermediaries, and/or vendors/agencies to ensure that patient information is current, accurate, and complete.

Contributes to the achievement of the Utilization Management Department goals through effective participation in department committees and informal work groups. Provides timely and continual coverage of assigned work area in order to ensure all accounts are completed.

Provides guidance to other members of assigned team regarding opportunities to improve processes.

May provide and/or maintain data and spreadsheets for leadership. Assists with tracking and/or trending data as needed.

Maintains up-to-date concurrent authorizations for in-house patients.

Coordinates the administrative aspects of the utilization review process involving authorizations, requests for clinical reviews, concurrent denial documents, messages received from payors and identify issues needing further resolution. Determine appropriate UR RN reviewer and refer for handling if necessary.

Requirements:

Education:

High School Diploma or GED required. Associate Degree or College Diploma in Business, Health or a related field preferred.

Experience:

  • Minimum of 1 year's experience hospital in patient registration, commercial insurance/authorization handling, claims processing or utilization review required.
  • Minimum of 1 year's Acute Care experience preferred.

Why work here?

We take pride in hiring the best employees. Our talented staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.

  • Working Title: Case Management Assistant - Utilization Review
  • Department: Utilization Management
  • Business Entity: Corporate Services
  • City: Los Angeles
  • Job Category: Patient Services
  • Job Specialty: Case Management
  • Position Type: Part-time
  • Shift Length: 8 hour shift
  • Shift Type: Day

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.

At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu) and COVID-19. For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines such as COVID-19 as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.

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