Utilization Mgmt Support Specialist II

We are so glad you are interested in joining Sutter Health!

**Organization:**

SHSO-Population Health Services-Valley

**Position Overview:**

Accumulates, processes, interprets, and documents timely payer information to justify acute hospital admission, need for continued stay, and proper level of care billing based on clinical outcomes. Responsible for processing concurrent and retrospective denials in collaboration with clinical utilization management staff and internal physician advisors. Under the direction of management, develops, coordinates and monitors systems for the appeal/denial process, tracks and trends data, and coordinates utilization management operations activities with leadership and key stakeholders. Collaborates with other departments.
Monitors and acts as a liaison between leadership, external payers, staff, and other related services and departments to assist with troubleshooting, tracking, and trending the appropriate level of...