Utilization Management Coordinator at AdventHealth

Date Posted: 2/10/2021

Job Snapshot

  • Job Schedule
    Full-Time
  • Location:
    Tampa, FL
  • Date Posted:
    2/10/2021
  • Job ID:
    21002339
  • Job Family
    Case Management
  • Travel
    No
  • Shift
    1 - Day

Job Description


Description

Utilization Management Coordinator Virtual Role AdventHealth Tampa

Location Address: 3100 East Fletcher Avenue Tampa, Florida 33613

Top Reasons to Work at AdventHealth Tampa

  • AdventHealth Pepin Heart Institute, known across the country for its advances in cardiovascular disease prevention, diagnosis, treatment and research.
  • Surgical Pioneers – the first in Tampa with the latest robotics in spine surgery
  • Building a brand new, six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come
  • Awarded the Get With The Guidelines – Stroke GOLD Quality Achievement Award from the American Heart Association/American Stroke Association and have been recognized as a recipient of their Target: Stroke Honor Roll for our expertise in stroke care. We have also received certification by The Joint Commission in collaboration with the American Stroke Association as a Primary Stroke Center.

Work Hours/Shift:

Full Time Day

YOU ARE REQUIRED TO SUBMIT A RESUME WITH YOUR APPLICATION

You Will Be Responsible For:

  • Supports clerical and administrative activities of the Utilization Management team
  • Monitors and addresses electronic faxes and email from payors
  • Forwards communication to appropriate Utilization Management team member
  • Enters pertinent approval and denial information into the appropriate computer programs for Utilization Management team members to review and address in a timely manner
  • Monitors the Centralized Phone Line for telephonic authorization and denial information from payors
  • Manages and monitors mail from the department mailbox, which includes uploading letters from payors to patient encounters and forwarding correspondences to applicable Departments
  • Serves as a liaison for payor reviewer, PFS (Patient Financial Services), and Pre-Access
  • Works closely with the UM Specialist and Supervisor
  • Tracks and trends payor issues and potential contractual issues and escalates to Utilization Management leadership
  • Manages multiple clerical duties and assigned projects, while sustaining the department’s key initiatives in support of daily operational flows and special projects as required
  • Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level before releasing account information. 
  • Completes any other tasks within department guidelines
Qualifications

What You Will Need:

KNOWLEDGE AND SKILLS REQUIRED:

  • Understanding of Microsoft Office Products and other appropriate software platforms
  • Ability to communicate effectively and professionally via phone and email
  • Ability to manage multiple tasks and prioritize level of importance
  • Ability to perform duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety and a commitment to AH principles
  • Ability to work with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change
  • Ability to work with minimal supervision
  • Knowledge of Utilization Management processes preferred
  • Knowledge of Care Management processes/workflows preferred

EDUCATION AND EXPERIENCE REQUIRED:

  • High School diploma or GED
  • Associate degree and/or higher-level education, or completed coursework, in Health Services Administration or other related medical or business field preferred
  • Experience in health care, hospital setting, and/or Patient Finance Services preferred

Job Summary:

The Utilization Management (UM) Coordinator works under the direction of the Utilization Management Manager and supports the Utilization Management team with Emergency, Observation and Inpatient visits. The UM Coordinator is responsible for processing and documenting clinical requests, authorizations/approvals and denial communication from payors via fax (Vyne), email or phone. The UM Coordinator is responsible for collaborating with all members of the UM team or interdependent departments (i.e. Patient Access, Billing, etc.) to ensure unnecessary delays in patient care, discharge or billing.


This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

VIEW ALL JOBS BY:
Location | Organization | Category | Job Function