Care Management Technician II - Case Management - Bayfront Hospital - St Petersburg

Orlando Health•Saint Petersburg, FL

19h•Onsite

About The Position

The Care Management Technician II in the Care Management department initiates and obtains new insurance authorization requests for post-acute services. This role works collaboratively with the case management team, hospital care team, community partners, and insurance companies to ensure patient care needs are met regarding post-acute care prior authorizations. The technician will obtain and maintain contacts with insurance companies to streamline barrier removal, maintain knowledge of payer portal functionality and medical necessity requirements for post-acute care, and understand payer requirements and how to apply benefits in various circumstances for post-acute care. This position 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 OR associate’s degree in healthcare field with one year of experience in post-acute referral management OR One year of experience in post-acute insurance authorization

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