1101 Vermont Ave NW Suite 1200 Washington, DC 20005 Kids Are Our Everything. Department 10522 HSCSN - Utilization Management Pay Range $19.65 - $32.75 Works under the direction of the Director of Utilization Management and UM Review staff. Provides support to UM Reviewers by: managing the UM Department's main phone line and transfers calls to appropriate staff as indicated, opening UM cases by creating authorization shells in the HSCSN electronic Record, sending requests for review to the appropriate UM reviewer based on service being requested and attaching documents related to UM activities to the HSCSN electronic record. Minimum Education High School Diploma or GED (Required) Associate's Degree (Preferred) Minimum Work Experience 2 years related experience in managed care. (Preferred) Required Skills/Knowledge Knowledge of medical terminology. Demonstrated skills and ability to work collaboratively in a team environment. Strong written and oral communication skills. Strong organizational skills. Computer literate in Microsoft suite. Required Licenses and Certifications Driver's License (Preferred) Job Functions Essential job duties: Obtains clinical information required for review and documentation of precertification requests and routes to the appropriate individuals for processing. Monitors fax machines, faxes queues, and mail for authorization/reauthorization requests and routes information timely to the appropriate individuals for processes. Receives calls from enrollees and providers, assesses nature of call and completes requests. Answers inquiries from enrollees/caregivers and providers, and routes to appropriate review nurse or Chief Medical Officer. Assist clinical staff identifying and securing vendors for services requiring prior authorization (home health, supplies, durable medical equipment, etc.). Enters authorizations and/or provides service authorizations to vendors as requested by clinical staff. Communicate authorization information to vendors timely and accurately. Documents all relevant information and communication, links documents or other information in the HSCSN IT system. Seeks advice from UM Director or other designated person(s) with expertise in specialty areas when necessary. Effectively resolves inquires related to status of authorization requests. Provides accurate and timely documentation to care management staff in the IT system. Identifies and seeks guidance for potential risks and utilization concerns. Demonstrates compliance with authorization timeliness and case closure. Documents according to policy as it related to authorization process. Researches and answers provider and vendor authorization inquiries. Demonstrates customer service, evidenced by no reports of complaints, or non-responses to e-mails or phone calls. Demonstrates compliance with work flow and department processes. Demonstrates customer service, and phone etiquette. Demonstrates time and attendance. Other job duties: May perform other duties in addition to those outlined in this job description. The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children’s National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible. Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster. Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana. Thank you for your interest in joining our exceptional team at Health Services for Children with Special Needs, Inc. (HSCSN). We are committed to providing the personalized attention and high-quality care our enrollees need to lead fulfilling lives. Introduce yourself to our recruiting team, and we will reach out to you if a role aligns with your skills and experience. About Us Health Services for Children with Special Needs, Inc. (HSCSN) is the managed care plan contracted with the District of Columbia to administer the Child and Adolescent Supplemental Security Income Program (CASSIP) for children and young adults to age 26 years. HSCSN's mission is to coordinate innovative, high-quality, community-based care for individuals with complex needs and their families. HSCSN empowers all we serve to improve the quality of their lives. For more information about HSCSN, visit the website: HSCSN Health Services for Children with Special Needs | Health Services for Children with Special Needs, Inc. (HSCSN) (hscsnhealthplan.org) Recruitment Fraud Notice As fraudulent recruitment activities by individuals or organizations falsely claiming to represent hospitals are on the rise. Please be advised that: Official Communication: All legitimate communication regarding job opportunities will come from our official email addresses and website. Any correspondence related to Health Services for Children with Special Needs, Inc. from a personal email such as Yahoo, Gmail, iCloud, etc. is fraudulent. Application Process: We will never ask for payment or personal financial information as part of the recruitment process. All applications will be submitted through our applicant tracking system and can be found on our careers site. Careers. Verification: If you receive any suspicious communication, please verify its authenticity by contacting us directly at talentacquisitionconsultants @childrensnational.org Your safety and security are our priority. If you suspect recruitment fraud, report it to us immediately.

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