Case Management Extender- Utilization Review

Tampa General Hospital•Tampa, FL

About The Position

Assists Case Managers and Social Workers in achieving the goals of the Case Management department through the successful completion of removing accounts from the Do Not Bill work queue and discharge planning. This includes payer communication, certification and authorization, supporting case managers with admission and concurrent denial avoidance, timely delivery, documentation, and tracking of “Important Message” notices to Medicare patients or representatives, provision of complete clinical information to a continuum of post-acute care providers including follow up, and coordination of facility placements, transportation, home healthcare and other community support services that ensure a safe and appropriate patient discharge and prevent re-hospitalization. Utilizes department tools and resources to organize and prioritize caseload and complete priorities. Supports the efforts of HIM and Patient Accounts by ensuring timely, accurate, and complete data entry in multiple information systems/data bases. Brings workflow barriers or issues to the attention of the Supervisor of Case Management and/or the Manager of Utilization Management in an expedient manner. Maintains excellent working relationships with payers and post-acute providers. Ensures that flow of information, including delays, to Case Managers and Social Workers is timely and accurate. Demonstrates ability to multitask and exhibits attention to detail. Responsible for performing job duties in accordance with the mission, vision, and values of Tampa General Hospital.

Requirements

High School Diploma or GED required
Medical terminology required
Must be computer literate
Have experience with internet browsers
Familiarity with Microsoft Office

Nice To Haves

Associates degree in Social Work or related field is preferred
Two (2) years’ experience in utilization management and hospital case management/ social service and/or managed care performing discharge planning, interfacing with insurance companies and/or utilization review may substitute for the degree

Responsibilities

Payer communication, certification and authorization
Supports case managers with admission and concurrent denial avoidance
Timely delivery, documentation, and tracking of “Important Message” notices to Medicare patient or representative
Provision of complete clinical information to a continuum of post-acute care providers including follow up with providers to ensure information was received and is complete
Coordination of facility placements, transportation, home healthcare and other community support services that ensure a safe and appropriate patient discharge, and prevent re-hospitalization
Utilizes department tools and resources to organize and prioritize case load and completing priorities
Supports the efforts of HIM and Patient Accounts by ensuring timely, accurate, and complete data entry in multiple information systems/data bases
Brings workflow barriers or issues to the attention of the Supervisor of Case Management and or the Manager of Utilization Management in an expedient manner
Maintains excellent working relationships with payers and post-acute providers
Ensures that flow of information, including delays, to Case Managers and Social Workers is timely and accurate