Care Management Technician II, Full-Time Days

Facility: South Lake Hospital

Location: Clermont, FL

Status: Full-Time

Department: Care Management

Schedule: Days

Title: Care Management Technician II

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“Orlando Health Is Your Best Place to Work” is not just something we say, it’s our promise to you."

Orlando Health South Lake Hospital is a comprehensive medical and surgical acute care facility serving the residents of Lake County as a trusted member of the community for over 75 years. Conveniently located in Clermont, the hospital’s dedicated team of physicians, nurses, clinicians and medical professionals is committed to delivering expert and compassionate care. Our efforts have earned us recognition as a national leader.

Click Here to Learn About: South Lake Hospital

ORLANDO HEALTH - BENEFITS & PERKS:

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.

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.

Essential Functions

• 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.

Education/Training

• 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.

Licensure/Certification

• None

Experience

• Two years’ experience in post-acute insurance authorization. Candidates with discharge planning within hospital-based case management are strongly preferred for the role.