Top Reasons to work at AdventHealth Trickel Building
Faith based & mission driven organization
CREATION Health employee wellness and lifestyle programs
Positive working climate to support a work life balance
You Will Be Responsible For:
Supports UM staff daily and acts as a resource to the team for questions or issues that may arise.
Accountable for day-to-day functions of assigned area, ensuring all patient accounts are verified and authorized in a timely manner with appropriate follow up for account completion.
Supports department and team by ensuring patients receive a clinical review through system protocols accurately and timely. As needed, contacts insurance companies to address complex and challenging cases. Provides timely and continual coverage of assigned work area to ensure all accounts are completed.
Trains all new Utilization Management employees in basic functions of the UM department and in payer-specific rules and regulations. Supervises all new UM RN’s within the 90 days’ (or extended) probationary period and completes 90-day evaluations in association with the UM Manager.
Serves as first point of contact for initial communication with service partners and is the first stage of the escalation process to management. Accountable for maintaining a working relationship with all to ensure open communication.
What Will You Need:
EDUCATION AND EXPERIENCE REQUIRED:
Acute clinical experience of at least five (5) years
EDUCATION AND EXPERIENCE PREFERRED:
Acute clinical case management, discharge planning and/or utilization management experience in a healthcare clinical setting, i.e. hospital, managed care, home health, and/or Center for Medicare and Medicaid Services Programs, etc.
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:
LICENSURE, CERTIFICATION, OR REGISTRATION PREFERRED:
Certification specialty preferred in Utilization Management, Managed Care or other applicable professional certification
Actively participates in outstanding customer service and accept responsibility in maintaining relationships that are equally respectful to all. Under supervision, the UM nurse proactively coordinates case reviews for admission criteria, concurrent utilization of services, LOS (length of stay) and criteria for care, as well as retro reviews for all payers. Performs denial management activities as dictated by work flows and payer requests. Performs chart audits for all regulatory agencies as well as in-house hospital studies. Supports the campus-wide CM (case management), the physician and clinical teams in utilization activities and enhancing throughput.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.