Utilization Management Assistant

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As a Utilization Management Assistant, you will receive, process, facilitate and document all payer communications. This position supports denial mitigation by sending documentation within the contracted time period, following up on accounts lacking authorization, and communicating with internal stakeholders to ensure the accurate submission of clinical documentation to third‑party payers. The Utilization Management Assistant supports the Utilization Management Hub department by recognizing trends and opportunities for process improvement and reporting those to leadership.

All duties are performed with a high degree of accuracy using critical thinking skills in compliance with hospital policies, standards of practice, and Federal and State Regulations.

• Receive, send, and document payer requests for clinical documentation.
• Receive and document payer authorization and communications, including but not limited to concurrent denials.
• Coordinate peer‑to‑peer conversations, as applicable.
• Review surgery schedules to verify correct authorization is documented.
• Identify accounts lacking authorization and follow up with payers as needed.
• Communicate with interdepartmental staff regarding payer documentation requests.
• Under RN direction, submit requests for and follow up on administrative day(s) authorization, where indicated.
• Identify and report trends to department leadership.
• Utilize payer‑related reports from Care Management software, where applicable.
• Collaborate with and support the UM team, including but not limited to UR and Denials RNs.
• Contribute to the identification of opportunities for process improvement.
• Support administrative departmental functions, as assigned.

• Minimum one year experience in a hospital, physician’s office, or medical group performing duties related to admitting, business office, payer communications, or managed care, or an equivalent combination of education and experience.
• High school diploma or GED.

An understanding of operations and functions of care coordination, utilization management, and denial mitigation is preferred.

Common Spirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home‑based care and virtual care services, Common Spirit serves nearly one out of every four U.S. residents. Common Spirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

$19.87 – $28.06 per hour

Entry level

Full‑time

Administrative

Hospitals and Health Care