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.