Utilization Management Specialist at AdventHealth

Date Posted: 2/10/2021

Job Snapshot

  • Job Schedule
    Full-Time
  • Location:
    Tampa, FL
  • Date Posted:
    2/10/2021
  • Job ID:
    21002378
  • Job Family
    Case Management
  • Travel
    No
  • Shift
    1 - Day

Job Description


Description

Utilization Management Specialist 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:

  • Coordinates and supports clerical and administrative activities of the Utilization Management team
  • Collaborates and communicates with payor via phone, fax or payor portal
  • Submits clinical reviews to payors
  • Provides information to payors supporting admission /continued stay
  • Manages requests submitted from payors
  • Provides discharge dates to payors
  • Submits copies of UM activities to payors, as needed
  • Tracks and monitors requests through EMR
  • Ensures incoming requests are responded to promptly and accurately
  • Obtains and enters authorization numbers from payors
  • Verifies up-to-date concurrent authorizations for in-house patients
  • Reviews and monitors accounts to ensure proper documentation of benefits and authorizations have been completed in required fields and notes
  • Supports concurrent denials process
  • Assists in coordinating Peer-to-Peer discussions with the payor for Physician Advisors, Attending Physicians and UM RNs
  • Updates patient demographic/patient type/coverage, as needed
  • Assists UM Coordinator in managing central fax (Vyne)/email accounts (Central Repository), as needed
  • Communicates with all members of the Interdisciplinary Team (i.e., nurses, physicians, etc.), as needed
  • Assists department leadership with quality audits as needed
  • Timely escalates cases requiring clinical expertise to UM RNs
  • Interacts with physicians, physician office personnel, and/or care management departments on an to assure resolution of issues, as needed
  • Provides timely and continual coverage of assigned work area in order to ensure all accounts are completes
  • 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
  • Knowledge of Utilization Management
  • 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 Care Management processes / workflows preferred

EDUCATION AND EXPERIENCE REQUIRED:

  • High School diploma or GED
  • Two (2) years’ experience in Patient Access, Revenue Cycle Operations, Pre-Access, or related department
  • Associate degree and/or higher-level education, or completed coursework, in Health Services Administration or other related medical or business field preferred

Job Summary:

The Utilization Management (UM) Specialist works under the direction of the Utilization Management Manager and supports the Utilization Management team with Emergency, Observation and Inpatient visits. The UM Specialist is responsible for providing clerical assistance to the Utilization Management Nurses (UM RN) to assist with verification of benefits, authorization procurement and other assigned tasks as needed. The UM Specialist is responsible for collaborating with the UM RN and other members of the interdisciplinary team (i.e. Physicians, Care Managers, Social Workers, etc.) 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.

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