Intake/Utilization Mgmt Specialist Full time Days

The salary range for this position is $31.37 - $39.21 (Hourly Rate)

Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement.

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section located at jobs.nm.org/benefits to learn more.

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional, and financial well-being.

Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Description

Monday- Friday.

The Intake Specialist, Home Infusion Pharmacy reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

This role serves as the point-of-entry for the Home Infusion Pharmacy department.

Responsibilities:

• Engages in front-end utilization management and per-protocol onboarding procedures to ensure a safe, efficient, and accurate intake process for the pharmacy.
• Actively and effectively serves as a remotely functioning liaison for the home infusion pharmacy to case managers, social workers, physicians, and other referring partners.
• Monitor and respond to requests for Home Infusion Pharmacy services in an efficient, accurate, and professional manner via several platforms such as email, phone, and Allscripts/Careport, to name a few.
• Exercise autonomy when scrutinizing prospective referrals for acceptance. Navigate and leverage tools to make informed decisions about referral acceptance and denial. Maintain and update reference tools, as appropriate.
• Conduct eligibility verification, benefits investigation, test claims (when applicable), and prior authorizations for all cases related to Home Infusion Pharmacy. Assist in the coordination of appeals for prior authorization denials, when indicated. Must have ability to navigate and execute functions within health insurance electronic portals and/or communicate with payor representatives via telephone.
• Actively communicate with members of the care management team, patient care team, and pharmacy to provide status updates on referrals. Communication mode (email, phone, progress note, warm hand-off, etc.) may vary depending on the audience and situation.
• Work with Pharmacy software (CPR+) to create patient profiles and document communication notes in order to keep the Pharmacy team abreast of new information.
• Provide accurate information and timely updates to patients and customers. Addresses questions and concerns promptly, or identifies appropriate person and resources to do so.
• Participates in efforts to reduce costs, streamline work processes, improve and grow services provided.
• Utilizes department and hospital policies and procedures to complete assigned tasks.
• Demonstrates knowledge and compliance with insurance, local, state and federal regulations related to physician and hospital billing. Has a firm understanding of those home infusion services covered by commercial and federal payers.
• Participate in team meetings, quality improvement initiatives, and other activities as requested.
• Assist with the onboarding and training of new members of the team.
• Other responsibilities as assigned and indicated

Qualifications

Required:

• High School Diploma
• Two (2) years progressive work experience in any one of the following: hospital/physician utilization management. Also acceptable: retail pharmacy/PBM/Home Infusion as a billing representative, UM professional, patient services representative, and/or pharmacy technician.
• Knowledge of EPIC systems, Microsoft applications, referral platforms such as Allscripts/Careport, and CPR+. If has not engaged in these applications, must have the ability to quickly learn.
• Ability to manage multiple priorities in a fast-paced environment.
• Exceptional organizational skills and detail orientation which includes ability to prioritize tasks and keep records so they remain readily retrievable.
• Excellent customer service and communication skills
• Experience that has contributed to the understanding of insurance rules and regulations, especially Medicare and Medicaid.

Preferred:

• 2+ years college or college degree
• Five (5) years progressive work experience in any one of the following: hospital/physician utilization management. Also acceptable: retail pharmacy/PBM/Home Infusion as a billing representative, UM professional, patient services representative, and/or pharmacy technician.
• Call center, telephone work experience
• High-level problem solving, analytical, and investigational skills

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person. 

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events.

Click on or copy and paste URL to your browser to view detailed benefits information   

NorthwesternMedicine Career Page

https://jobs.nm.org/benefits

Please refer to the Benefits Eligibility by Employment Classification to determine benefits eligibility for job postings. 

If sign-on bonus is included in a job posting eligibility is as followed: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign-on bonus. Exception: New graduate internal employees seeking their first licensed clinical position as a Registered Nurse at NM may be eligible.