The Utilization Management Specialist (UMS) screens patients to determine the appropriate level of care through the use of clinical criteria, the Medicare Inpatient Only List, and individual payer requirements. The Utilization Management Specialist collects data, completes audits, and generates reports based on trends and various improvement initiatives. The Utilization Management Specialist interacts with Care Coordination, Coding, Revenue Integrity, Compliance, Physician Advisors, Physicians, and payers to establish level of care.
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The Sr. Manager will be responsible for the operations of the Deciphera AccessPoint™ Patient Support Program, which seeks to facilitate a positive patient experience by maximizing patient access and affordability for patients taking Deciphera’s products. The right candidate for this role is solution-oriented, detailed, creative, organized, flexible, and adept at working in an unstructured environment.