Offer summary

Qualifications:

Minimum of three years of experience in an acute care clinical setting., Active, current and unrestricted professional licensure as an RN or LPN in relevant states., Proficient in Microsoft Office applications including Word, Excel, Outlook, and PowerPoint., Strong understanding of standardized clinical criteria for medical necessity and utilization management..

Key responsabilities:

Perform review of clinical information to determine medical necessity and appropriate level of care.

Gather clinical information from healthcare providers and confirm medical necessity for procedures.

Conduct utilization management and consult with Peer Reviewers as needed.

Ensure timely follow-up on utilization management issues and collaborate with providers for discharge needs.

Job description

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, HPI is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

What you’ll do

The UM Review Coordinator performs review of clinical information submitted to determine medical necessity, appropriate level of care and length of stay, based on standardized clinical criteria. The UM Review Coordinator renders positive determinations for cases that meet the criteria and refers all other cases for physician peer review (“Peer Reviewer”).

In this role, you’ll also:

Gather relevant clinical information from appropriate health care providers
Confirm medical necessity for selected procedures and services based on application of standardized clinical criteria to clinical information submitted; if a positive determination cannot be made based on the criteria, refer case to Peer Reviewer
Conduct utilization management of appropriate level of care and length of stay using standardized clinical criteria
Consult with Peer Reviewers when a positive determination cannot be made based on the standardized criteria or peer consult is needed to determine appropriateness of care beyond the standardized criteria
Provide timely case screening to identify case management needs and generate appropriate referrals to Case Management or other appropriate clinical programs;
Ensure timely follow up on outstanding utilization management issues and inquiries
Collaborate with health care providers to identify discharge needs in order to facilitate timely discharge to an appropriate level of care, with referral to Case Management as appropriate
Communicate with providers and other health care professionals regarding the Utilization Management process
Ensure case documentation follows policy and procedure
Proactively manage professional growth by collaborating with Manager to identify as appropriate
Demonstrate consistent and appropriate application of standardized criteria for purposes of interrater reliability
Maintain satisfactory quality audit scores
Manage work time and caseload efficiently
Adherence to HIPAA policies and procedures

What you bring

A minimum of three years of experience in an acute care clinical setting.
Active, current and unrestricted professional licensure as an RN (Registered Nurse) or LPN (Licensed Practical Nurse) in Massachusetts, Maine, New Hampshire or state of residency
Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Why choose us?

Our space is a reflection of who we are—innovative, open and collaborative.
Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
We think feeling your best is an important factor in producing great work, so we embrace a “smart casual” dress code and work at ergonomic desks.
Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

Benefits

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we have to offer: