DaVita Utilization Management Screener in LAS VEGAS, Nevada

Utilization Management Screener

Description

DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Nevada, New Mexico, Florida, Colorado and Washington in its pursuit to deliver excellent-quality health care in a dignified and compassionate manner. As of June 30, 2016 DaVita Medical Group (formerly HealthCare Partners) provided integrated care management for approximately 760,000 patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.

We are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all.

If you're looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.

Overview:

Under general supervision, the Screener is responsible to collect and monitor routine to complex health care services data and verifies benefits/eligibility in an effort to improve those services using established policies, procedures and guidelines.The Screener receives and reviews, verifies and processes requests for a variety of medical services and answers company phone lines.The Screener will work closely with nurses on any case that requires the expertise of a nurse and requires medical judgment.

The Screener is accountable to investigate member history and eligibility as appropriate, contact Case Managers and PA nurses to gather further information, support the health plan needs to be cost effective and quality conscious, identify and report issues that may result in a grievance to ensure appropriate awareness, serve as a mentor to other team members, assist in training of staff and assist in the development of policies and procedures as requested.

Essential Functions:

  • Responsible for quality and continuous improvement within the job scope.

  • Responsible for all actions/responsibilities as described in company controlled documentation for this position.

  • Contributes to and supports the corporation’s quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporation’s quality improvement efforts.

  • At the request of the prior auth nurse, requests clinical information from the medical provider as appropriate.

  • Cover all company phone lines and assure these lines are always covered by two screeners before leaving their desk.

  • Maintains a courteous, professional attitude when working with facility staff, providers and their staff, the health plan and co-workers.

  • Reviews medical requests with the a nurse, manager and/or Medical Director and other team members as needed and appropriate prior to making any decisions they are unsure of.

  • Responsible for timely and accurate documentation in the computer system.

  • Documentation will be compliant with established standards which are monitored through audits.

  • Responsible to document ICD-10 and CPT coding and levels of care to reflect care and services provided for claim adjudication.

  • Works closely with nurses.

  • Participates in internal audit reporting as necessary

  • Active participation in team meetings.

  • Maintains a courteous, professional attitude when working with facility staff, providers and their staff, the health plan and co-workers.

Qualifications

Education :

  • High School Diploma or GED

Experience:

  • One to two years experience in a medical environment, working knowledge of medical terminology, ICD 10 and CPT coding.

  • This position requires experience handling heavy telephones, providing customer service to both internal and external customers and strong computer skills.

Knowledge, Skills and Abilities:

  • Clinical and critical thinking skills are essential along with excellent problem solving and decision making abilities.

  • Medical Terminology is recommended.

  • Good organization and detail oriented.

High School Diploma or GEDExperience:One to two years experience in a medical environment, working knowledge of medical terminology, ICD 10 and CPT coding.This position requires experience handling heavy telephones, providing customer service to both internal and external customers and strong computer skills.Knowledge, Skills and Abilities:Clinical and critical thinking skills are essential along with excellent problem solving and decision making abilities.Medical Terminology is recommended.Good organization and detail oriented.

Primary Location NV-LAS VEGAS - 89119

Req ID: 308792