Utilization Management Extender- Utilization Management

A Brief Overview
The Utilization Management Extender (UME) is a front‑end Utilization Management support role with direct revenue impact, responsible for ensuring that authorization, notification, and utilization workflows are completed accurately and timely to support reimbursement. This role focuses on admission authorizations, level‑of‑care changes, and concurrent review requirements, while validating that all UM actions are properly documented and aligned with payer rules.



What you will do

• Confirm payer receipt and completeness of submitted documentation to prevent downstream denials. Support front‑end Utilization Management workflows by validating admission authorizations, notifications, level‑of‑care changes, and concurrent review requirements.
• Collaborate with the Case Management team to submit, track, and follow determinations for Acentra QIO appeals, ensuring timely and complete documentation.
• Submit and follow up on Notifications of Admission (NOA), level‑of‑care changes, and concurrent clinical submissions when authorization gaps are identified post‑discharge.
• Reconcile authorization activity throughout the patient stay to ensure required UM actions are completed and accurately documented.
• Manage UM‑related Discharged Not Billed (DNB) work queues by identifying and resolving authorization‑related barriers to claim release.
• Validate authorization details (payer, facility, level of care, length of stay, dates of service) to ensure billing readiness.
• Remove UM‑related billing holds by correcting missing, incomplete, or inconsistent authorization documentation.
• Perform denial avoidance reviews for high‑risk and high‑dollar accounts and identify authorization‑related trends impacting reimbursement.
• Submit, reconcile, and follow up on required notifications (e.g., NOA, OBS‑to‑IP conversions, concurrent reviews) when gaps are identified.
• Respond to payer correspondence, medical record requests, and authorization inquiries; confirm receipt and completeness of submitted documentation.
• Maintain clear, detailed documentation of payer communications and authorization activity within Epic.
• Collaborate with Utilization Management, Revenue Integrity, Coding, HIM, Billing, and Patient Access teams to resolve discrepancies.
• Track, trend, and report authorization and UM workflow issues using dashboards and work queues.
• Escalate complex authorization or payer issues to UM leadership or Physician Advisors as appropriate.
• Provide feedback and education to internal teams regarding documentation or process gaps contributing to denials or delays.
• Participate in audits, meetings, and process improvement initiatives related to UM and revenue cycle performance.