Overview

　　St. Luke’s Health System in Boise is seeking a Utilization Review Technician to join our Utilization Review team.

　　The Utilization Review Technician, under direction of a RN, is responsible for providing accurate and timely technical and administrative support across the utilization review process.

　　Responsibilities

　　The Utilization Review Technician, under direction of a RN, is responsible for providing accurate and timely technical and administrative support across the utilization review process.

　　Coordinates, generates and tracks both incoming and outgoing correspondence, faxes and authorizations related to prospective, concurrent and post-service review functions. Receives calls, faxes and portal submissions from providers regarding authorization requests and process inquiries for plan members.

　　Obtains authorizations required by various payers, including verification of patient demographic information, codes, dates of service, and clinical data. Re-certifies services when necessary.

　　Provides necessary information regarding authorization numbers and patient demographic information to appropriate staff, including billing. Interacts with facilities, vendors, providers, and other staff to facilitate receipt of information, and/or records for prompt review and response.

　　Provides information about the referral process to physician and staff and informs them of eligibility issues. Screens information received from providers for needed information for authorization requests.

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　　Works with providers to correct authorization to claim issues.

　　Generates and assigns cases for review and works with staff and patients regarding denials and appeals.

　　Documents and maintains records of all referral activity and authorizations. Acts as a resource to staff for questions related to the prior authorization process.

　　Answers questions accurately and timely regarding Utilization Management requirements for members and providers. Identifies and reports member and provider educational opportunities to the Manager.

　　Other duties and responsibilities as assigned.

　　Qualifications

　　Education: Associate degree or 2 additional years of experience in lieu of degree.

　　Experience: 2 years' experience

　　Licenses/Certifications: None

　　Why St. Luke's

　　A strong, talented staff is at the heart of St. Luke’s Health System. We are the state’s largest employer with more than 15,000 employees and a medical staff of more than 1,800 physicians and advanced practice providers. We’re proud of our people who deliver skilled, compassionate care every day, and are looking to add dedicated individuals who will continue this same tradition of excellence.

　　*St. Luke’s is an equal opportunity employer without regard to race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

　　Default: Location : City Boise

　　Category Admin/Clerical/Customer Support

　　Work Unit Utilization Management System Office

　　Position Type Full-Time

　　Work Schedule VARIABLE

　　Requisition ID 2023-81819

　　Default: Location : Location US-ID-Boise

　　Work Location : Name 701 Morrison Knudsen Dr, Boise, St Luke's Plaza 2