Job Abstract

The Case Management Representative (CMR) coordinates the day-to-day operations of Utilization Management by providing all insurance companies with the information required to obtain approved days. Directing all denials and appeals to the appropriate person or team. The CMR will submit reviews in a timely manner for payers. Review, index, and/or respond appropriately to payer communication via OnBase. The CMR provides all communication with the insurance company to obtain approved days for the patient’s encounter. Serves as the liaison between various departments in the hospital, including HIM, Business Office, physicians' offices, and Access Services. Coordinates Medical Management Tracker, denial log, and TQ reports. This position is responsible for communicating the essential information to obtain approved for bed days from the insurance company. This communication is the driver for the payment received from the insurance company.