Care Management Technician II, Full-Time Days

Orlando Health • Clermont, FL

19d • Onsite

About The Position

The Care Management Technician II in the Care Management department is responsible for initiating and obtaining new insurance authorization requests for post-acute services. Works collaboratively with case management team, hospital care team, community partners, and insurance companies to ensure that patient care needs are met regarding post-acute care prior authorizations. Obtains and maintains contacts with insurance companies to streamline barrier removal. Maintains knowledge of payer portal functionality and medical necessity requirements for post-acute care. Understands payer requirements and how to apply benefits in
various circumstances for post-acute care and is responsible for identifying medical criteria for post-acute care from chart review and developing an effective clinical packet to justify the level of care needed.

Requirements

• High school diploma/GED
• Solid computer skills, including proficiency with Microsoft software. Demonstrated proficiency in communicating sensitive complex information to persons in a hospital environment.
• Demonstrates the ability to work independently and execute their own workload.
• Critical thinking ability necessary to prioritize workload to ensure tasks are completed in a timely manner and within established timeframe. Interpersonal skills necessary to facilitate interpersonal communication with team members, department staff, and external personnel, interact with patients/families, and perform other activities requiring courtesy and tact.
• Two years’ experience in post-acute insurance authorization.

Nice To Haves

• Candidates with discharge planning within hospital-based case management are strongly preferred for the role.

Responsibilities

• Maintains reasonably regular, punctual attendance consistent with Orlando health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando health policies and procedures.
• Develops collaborative relationships with hospitals, physicians, community organizations, team members, post-acute facilities and other referral sources.
• Verifies insurance coverage and obtains authorization
• Maintains authorization log
• Facilitates peer to peers for escalations for authorizations between facilities.
• Works with IT to refine post-acute authorization processes and polices for the organization
• Documents authorization workflows and best practices
• Monitor and obtain updates for authorization requests initiated by post-acute care facilities
• Assists with other Care Management requests as needed, including, but not limited to, patient assessments, delivery of regulatory notices and arranging patient transportation.
• Maintains reasonably regular, punctual attendance consistent with Orlando health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando health policies and procedures.
• Performs all other duties as assigned.

Benefits

• Competitive Pay
• Evening, nights, and weekend shift differentials offered for qualifying positions.
• All Inclusive Benefits (start day one)
• Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees.
• Employee-centric
• South Lake Hospital has been selected as one of the “Best Places to Work in Healthcare” by Modern Healthcare.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED