At Memorial Sloan Kettering (MSK), we're not only changing the way we treat cancer, but also the way the world thinks about it. By working together and pushing forward with innovation and discovery, we're driving excellence and improving outcomes.
For the 27th year, MSK has been named a top hospital for cancer by U.S. News & World Report. We are proud to be on Becker's Healthcare list as one of the 150 Great Places to Work in Healthcare in 2016, as well as Glassdoor's annual Employees' Choice Awards 2017. We're treating cancer, one patient at a time. Join us and make a difference every day.
Utilization Specialist Case Management
Hours: 9 am-5 pm (Monday to Friday)
Providers of compassionate, evidence-based nursing care to Oncology patients and families living with cancer in a healing and innovative environment.
Action-oriented and eager to embrace new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
A good decision-maker, with proven success at making timely decisions that maintains high standards of patient care within the organization.
Actively seeking new ways to grow and be challenged, using both formal and informal development.
Approachable and comfortable with diverse groups of people and able to make others comfortable with you.
An effective communicator, capable of determining how best to reach different audiences and executing communications based on that understanding.
Capable of building strong customer relationships and delivering customer-centric care solutions.
Collect and provide clinical information for the inpatient population to insurance companies and review organizations to support the release of payment for the medical services provided.
Complete admission reviews for assigned patients on a timely basis.
Review electronic medical records using standard review criteria to evaluate medical acuity of the patient that demonstrates the need for the continued stay in the acute care setting.
Communicate with insurance companies through the payor review process and telephonically.
Coordinate and submit retrospective reviews with insurance companies
Confer with RN Case Manager and Clinical staff regarding treatment, to understand clinical rationale for variances from the plan.
Provide information to staff on insurance provisions and benefits as related to care at MSKCC.
Provide clinical information as per Case Management policies maintaining HIPPA compliance.
Current NYS LPN License/Registration preferred
Associates or Baccalaureate degree with either health related or RRA certification required
2-4 years hospital, utilization review /case management experience with an insurance company and or review organization or 3 years medical record abstracting
Excellent problem solving and communication skills
Knowledge of state and federal regulations that govern health insurance coverage
Knowledge of Microsoft: Outlook, Word, Excel and Internet Explorer.
Knowledge of Allscripts/ACM preferred #L
MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
As one of the world's premier cancer centers, Memorial Sloan-Kettering Cancer Center is committed to exceptional patient care, leading-edge research, a...nd superb educational programs. The close collaboration between our physicians and scientists is one of our unique strengths, enabling us to provide patients with the best care available today as we work to discover more effective strategies to prevent, control, and ultimately cure cancer in the future. Our education programs train future physicians and scientists, and the knowledge and experience they gain at Memorial Sloan-Kettering has an impact on cancer treatment and the biomedical research agenda around the world.