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Utilization Management Technician and Auditor

Bryan Health • Grand Island, NE, US • published 2026-10-10 03:03:06.992266

Description

GENERAL SUMMARY: Responsible for supporting the Utilization Management team by obtaining documentation/signatures needed for insurance purposes and the ability to explain the required documents to patients in our care. Using knowledge of insurance criteria and guidelines to ensure that the appropriate insurance(s) have been loaded for each patient. Monitors, assists with, and notates utilization activities including but not limited to denials, authorizations, appeals and retro authorizations for patients under the direction of Utilization Management. Responsible for ensuring coding and authorization reviews are completed, and we have an appropriate authorization on file for the procedure being ordered. Ensures documentation is provided for insurance company requests and/or determinations. Collaborates in an interdisciplinary manner to optimize patient care, quality reimbursement, and regulatory compliance. PRINCIPAL JOB FUNCTIONS: * Commits to the mission, vision, beliefs and consistently demonstrates our core values. * Understands and operationalizes federal regulations regarding Advance Directives, COBRA, Medicare, Corporate Compliance, Joint Commission, OSHA and HIPAA; reports s...

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