Trustmark’s mission is to improve wellbeing – for everyone.  It is a mission grounded in a belief in equality and born from our caring culture.  It is a culture we can only realize by building trust.  Trust established by ensuring associates feel respected, valued and heard.  At Trustmark, you’ll work collaboratively to transform lives and help people, communities and businesses thrive. Flourish in a culture of diversity and inclusion where appreciation, mutual respect and trust are constants, not just for our customers but for ourselves. At Trustmark, we have a commitment to welcoming people, no matter their background, identity or experience, to a workplace where they feel safe being their whole, authentic selves. A workplace made up of diverse, empowered individuals that allows ideas to thrive and enables us to bring the best to our colleagues, clients and communities. 

POSITION OVERVIEW:  Our Healthcare Management team is growing and currently looking for a UTILIZATION MANAGEMENT COORDINATOR.  In this role, you will be responsible for the day-to-day operations of the Healthcare Management Program and the analysis of as it relates to the Utilization Management Process.

THIS POSITION IS A REMOTE POSITION OPEN TO CANDIDATES LIVING IN THE UNITED STATES.  

RESPONSIBILITIES:

• Performs prospective, concurrent, and retrospective reviews to ensure the medical necessity and appropriateness of all hospital admissions and continues stays utilizing nationally recognized medical management criteria.
• Performs discharge-planning coordination unless this function is performed by a RN Care Manager.
• Identifies alternative care interventions based on quality of care and cost effectiveness and communicates these options to the attending physician.
• Performs certification of outpatient surgeries and treatment.
• Performs prospective, concurrent and retrospective review of ancillary services.
• Conducts mandatory and discretionary second surgical opinion process.
• Refers all cases that do not meet applicable criteria or need a plan of care review to a Physician Advisor.
• Assists with the orientation of new Healthcare Management personnel and contributes to the ongoing networking of expertise with co-workers.
• Performs medical claims review as required.
• Makes recommendations for system development from a user’s perspective.
• Assists in the preparation of reports that analyze and track quality of service and utilization statistics.
• Complies with Healthcare Management policies and procedures and conforms to the current URAC Utilization Management Standards while performing the job function.
• Promptly review, complete and acknowledge educational activities, which may include webinars, educational articles, etc. on an ongoing basis to comply with HCM continuing education requirements.
• Acts as a resource to colleagues and all other associates and clients.

QUALIFICATIONS:

• Bachelor of Science in Nursing preferred, active RN License required
• 2+ years of experience in a clinical setting
• Possess strong time management and organizational skills
• Excellent customer service, interpersonal, communication and critical thinking skills
• Ability to work independently and complete tasks in a timely manner, reprioritizing workload to meet customer and business needs
• Willingness to adjust and adapt to meet the business needs in an atmosphere that sometimes requires rapid change
• Ability to maintain high level of confidentiality, flexibility and willingness to learn new tasks;
• Ability to work in a dynamic team-oriented environment along with independently with minimal supervision
• Comfort with telephonic and written communications with all levels of leadership within the organization, providers, stop loss carriers and business contacts  in an efficient, professional manner
• Comfort with using digital applications including digital documentation system and the ability to accurately document digitally while engaging callers or reviewing medical documents
• Prior Utilization Management or Case Management experience preferred

Come join Trustmark! Join a team that will not only utilize your current skills but will enhance them as well. Trustmark benefits include health/dental/vision, life insurance, FSA and HSA, 401(k) plan, Employee Assistant Program, Back-up Care for Children, Adults and Elders and many health and wellness initiatives.  We also offer a Wellness program that enables employees to participate in health initiatives to reduce their insurance premiums.

FOR THE SECOND CONSECUTIVE YEAR WE WERE SELECTED AS A TOP WORKPLACE BY THE CHICAGO TRIBUNE. The award is based exclusively on Trustmark associate responses to an anonymous survey. The survey measured 15 key drivers of engaged cultures that are critical to the success of an organization. 

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, or disability.

Required Skills Required Experience