Warbird Consulting Partners

Interim Utilization Reviewer Consultant

Location
Tennessee
Pos. Category
Healthcare - Consulting
Experience (Years)
5
# Positions
1
Job ID
6192

Job Description

Warbird is seeking an Interim Utilization Review Consultant for an opportunity to assist a client with the development and implementation of a strong and effective infrastructure for the Utilization Management (UM) function across the organization and to manage the day to day operations.

 

Warbird engages talent and expertise across all of our practice areas and assembles experienced teams to solve a wide range of complex, pressing accounting and finance issues. Our consultants typically have 15-25 years plus of industry experience and know firsthand the daily challenges our clients encounter. We fit our consultants’ skills to the needs of our clients to ensure a successful experience for all. If you’re ready to take on the challenge, then let us help you advance your career in consulting!

 

 Objectives:

  • Create an effective and timely UM strategy with a goal of reviewing patients at the time and entry-point of admission
  • Design and implement process flows for emergency department, inpatient, observation, hospital-issued notices of non-coverage, Medicare outpatient observation notice and condition code 44
  • Develop a methodology to obtain data from UM daily functions necessary for root cause analysis aimed at preventing denials
  • Implement daily, weekly and monthly reporting packages to include key performance matrix
  • Conduct reviews, evaluate, screen cases, communicate with team and physicians on case status, supporting case planning tasks and following up on plan case plans
  • Implement a process to track payor denials to include timely filing, medical necessity, prior authorization and other denial types impacted by the UM Department daily functions
  • Work with the UM Manager to create a interim solution to drive and track daily UM activities while the client evaluates, identifies and implements a technology solution
  • This is a hands-on role as a reviewer

Job Requirements

EDUCATION/CERTIFICATIONS/REQUIREMENTS:

  • Bachelor’s Degree in Healthcare, Business or related field is required
  • RN required
  • ON SITE 4 days a week is required, Monday - Thursday
  • +5 years’ experience overall within Utilization Management/Authorization/etc., or three to five (3-5) years of experience in revenue cycle processes/integrity/case utilization
  • Excellent written, organizational, analytical, motivational and critical thinking skills
  • Excellent verbal and written communication skills; ability to engage with all clinical and financial leaders in achieving organizational deliverables

 

Project starts as 3 months and could extend to 6-12 months; weekly travel from Mon-Thursday required for each week to client site in Tennessee.  

 

Warbird is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, religion or other legally protected status.  E-Verify - Warbird participates in the Electronic Employment Eligibility Verification Program.

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