Utilization Management Specialist
AdventHealth Tampa Posted on 2022-11-18
| Salary | Not mentioned |
|---|---|
| Location | Remote in Tampa, FL |
| Type | Full-time |
Job Description
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Student Loan Repayment Program
- Career Development
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full Time
Shift: Monday- Friday 8a- 4:30pm
Location: Remote
The community you’ll be caring for: AdventHealth West Florida Division
- Rollover PDO with service year increases in accrual
- Comprehensive benefits package; including tuition reimbursement and matching 403b plan
- Patient facing positions receiving company paid initial sets of scrubs
- Company Discount programs
- Growing Organization
- Reimbursement for clinical position certifications
The role you’ll contribute:
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.
The UM Specialist will serve as the first point of escalation for payors requiring assistance in gaining additional or missing information to support authorization. The UM Specialist will be responsible for ensuring procurement of authorization upon admission and discharge as well as, accuracy of authorization information. The UM Specialist will ensure timely escalation of barriers to authorization requiring clinical expertise and assist in coordination of Peer to Peer discussions with the payor.
The value you’ll bring to the team:
- 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
Qualifications
The expertise and experiences you’ll need to succeed:
- High School diploma or GED
- Two (2) years’ experience in Patient Access, Revenue Cycle Operations, Pre-Access, or related department
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
Company description:
We have celebrated many firsts in Tampa »s health care history since we opened our doors in 1968. Today, we continue to offer innovative medicine as we elevate health care in the region. Our diverse clinical specialties include cardiovascular care, neurosciences, orthopedics, women »s health, cancer and surgery. Our skilled surgeons not only utilize minimally invasive and robotic-assisted procedures, but they are also leaders in improving these advanced techniques. We are also home for the AdventHealth Pepin Heart Institute, known across the country for advances in cardiovascular disease prevention, diagnosis, treatment and research. And we »re continuing the make history. Through our clinical research program, we apply the very latest advancements in medical technology to medical treatments that can be used today. With the clinical expertise, innovation and compassion of our team members, we »re changing the way people look at health care. Taneja Center for Innovative Surgery, Surgical Tower Expansion (Opening 2021) • New 6-story surgical/patient care tower adding 314,000 square feet to the facility • Upon opening, 96 private patient rooms (with room to add additional 36) • Upon opening, 18 new operating rooms (with room to add additional 6) • $256 million investment Notable First, Best and Only Achievements • First in Tampa and among the first in the country to perform the TAVR procedure • First in Tampa to offer Watchman procedure to reduce stroke risk in patients with aFib • First in Tampa to utilize the Impella RP heart pump on patient with right-side heart failure • First and only facility in Tampa to offer molecular breast imaging • Home to the only surgeon in Florida doing ALPPS procedure for the liver • Highest minimally invasive robotic liver cases in the state of Florida • Only site in country offering single incision gallbladder surgery with epidural anesthesia • Pioneers of single incision laparoscopic (scar-less) surgery • One of the first/only facilities in Tampa Bay to have a 24/7 neuro-interventional radiologist to treat stroke and other life-threatening conditions of the nervous system • First and only hospital in the southeastern U.S. to use Synaptive Medical Inc.’s BrightMatter™ system with next generation Modus V digital microscope and robotic arm • Tampa’s first and AdventHealth’s only fully dedicated epilepsy monitoring unit equipped with telemedicine capabilities • Only accredited CARF Inpatient rehabilitation facility in north Hillsborough county • First accredited sleep lab in Tampa Bay by the American Academy of Sleep Medicine • AdventHealth Tampa and AdventHealth Carrollwood are only facilities in Tampa with accreditation with distinction by Undersea & Hyperbaric Medical Society
Follow us