Company Description

Harrison Memorial Hospital (HMH), located in Cynthiana, Kentucky, is a 61-bed, independent, non-profit healthcare facility dedicated to providing high-quality medical services to our community since 1906. We are accredited by The Joint Commission and certified by Medicare and Medicaid, reflecting our commitment to excellence in patient care.

A Growing Network of Care

HMH is proud to offer comprehensive healthcare services through our diverse facilities and programs, including:

Harrison Memorial Hospital – A leading independent, not-for-profit hospital, providing cutting-edge medical care with a patient-centered approach.

Rural Health Clinics (RHCs) – Bringing quality primary care closer to our community, ensuring access to essential healthcare services in rural areas.

EMS Office – A highly trained Emergency Medical Services team, delivering rapid response and lifesaving care when it matters most.

KidTown Daycare – A trusted childcare facility dedicated to providing a safe, nurturing, and educational environment for our employees' families.

Specialty Clinics – Offering advanced specialty care, including cardiology, orthopedics, general surgery, and more, ensuring patients receive expert care close to home.

Clinic Pharmacy – Providing convenient, personalized pharmacy services, ensuring seamless medication management for our patients and community.

At HMH, we are committed to fostering a collaborative and supportive work environment where healthcare professionals can thrive and make a meaningful impact on the health and well-being of our community.
Join us at Harrison Memorial Hospital, where you can be part of a dedicated team delivering exceptional healthcare in a community-focused setting.

Job Summary/Purpose

The Utilization Management (UM) Specialist coordinates and processes direct access referrals and prior authorization documentation for scheduled services and procedures. This role ensures accurate data entry, timely communication with providers, and strict adherence to payer guidelines, TJC standards, and HIPAA privacy rules.

Essential Key Job Responsibilities

·        Receive, verify, and process direct referrals from providers with accuracy and timeliness

·        Verify patient eligibility, benefits, and authorization requirements through payer portals and EMR.

·        Enter and track referrals and authorizations in online systems, ensuring compliant turnaround times.

·        Communicate authorization determinations to providers and patients via phone, fax, or secure messaging.

·        Maintain organized logs of pending and approved authorizations for audit readiness.

·        Report delays, barriers, or denials to the UM Review Nurse or Director.

·        Support Health Plan Audits and departmental quality improvement initiatives.

·        Maintain exceptional attention to detail and accuracy in all documentation and data entry.

·        Protect patient information and comply with HIPAA regulations.

·        Assist with mail qualifications, fax monitoring, and other clerical tasks as assigned.

Role Minimum Qualifications

Required Education

·        High school diploma or equivalent

Required Minimum Knowledge, Skills and Abilities

·        Minimum 1 year of experience in scheduling, insurance verification, or revenue cycle

·        Strong communication and organizational skills.