The State of Minnesota is dedicated to improving the well-being of its residents and is seeking a Utilization Reviewer. This role involves assessing patient medical records to ensure the necessity of treatment and services, conducting both on-site and electronic reviews, and coordinating with billing processes.
Responsibilities
- Conduct electronic admission and medical record reviews to assess level of care and program service needs
- Participate in data collection and analysis of utilization management information
- Coordinate utilization review activities with program’s billing processes
- Participate in development and implementation of utilization management training efforts
Skills
- One (1) year of experience in health care utilization review that demonstrates the following: Experience in health insurance and/or billing. Experience with admission reviews and continued stay reviews. Data collection and analysis using computer systems and applications. Collaborating with third-party payers and service providers
- OR
- Three (3) years administrative support experience in health care utilization review that demonstrates the following: Experience in health insurance and/or billing. Process and enter verified data using computer systems and applications. Support and communicate data in a clear and concise manner. Support in the completion of admission reviews and continued stay reviews. Collaborating with third-party payers and service providers
- A bachelor's degree in psychology, business management, healthcare administration, nursing or related field may substitute for 1 year of advanced technical or paraprofessional experience
- To facilitate proper crediting, please ensure that your resume clearly describes your experience in the areas listed and indicates the beginning and ending month and year for each job held
- REFERENCE/BACKGROUND CHECKS – Direct Care & Treatment will conduct reference checks to verify job-related credentials and criminal background check prior to appointment
- EDUCATION VERIFICATION - Applicants will be required to provide a copy of their high school diploma at time of interview OR copies of their college transcript or college degree/diploma at time of interview. Copies of the college degree/diploma are acceptable ONLY if it clearly identifies the field in which it was earned
- Direct Care & Treatment (DCT) healthcare facilities require employees to provide documentation that they are free from tuberculosis (TB) through a blood test prior to employment. DCT does not accept TB skin testing
- Bachelor's degree in psychology, business management, healthcare administration, nursing, or related field
- Experience with care delivery in a behavioral health facility
- Preferred candidates will have a variety of experiences working effectively with others from different backgrounds and cultures
Benefits
- Paid vacation and sick leave
- 12 paid holidays each year
- Annual pay increases
- Low-cost medical, dental, vision, and prescription drug plans
- Fertility care, including IVF
- Diabetes care
- Dental and orthodontic care for adults and children
- 6 weeks paid leave for parents of newborn or newly adopted children
- Pension plan that provides income when you retire (after working at least three years)
- Employer paid life insurance to provide support for your family in the event of death
- Short-term and long-term disability insurance that can provide income if you are unable to work due to illness or injury
- Tax-free expense accounts for health, dental, and dependent care
- Resources that provide support and promote physical, emotional, social, and financial well-being
- Training, classes, and professional development
- Federal Public Service Loan Forgiveness Program (Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, visit the Federal Student Aid website at studentaid.gov)
- Employee Assistance Program (EAP) for work/life support
- A voluntary confidential program that helps employees and their families with life challenges that may impact overall health, personal well-being, or job performance
- Common sources of stress can be addressed through the EAP: mental health, relationship challenges (personal and work), grief and loss, finances, and legal issues
- Daily Living/Convenience Services: Chore services, home repair, trip planning, child/elder care
Company Overview
- State of Minnesota provides information for residents, businesses, government, employment, education, and travel. It was founded in 1858, and is headquartered in Saint Paul, Minnesota, USA, with a workforce of 10001+ employees. Its website is https://mn.gov.