Care Management Technician II - Full Time Days

Position Summary:

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

 

About Orlando Health Melbourne Hospital

Orlando Health Melbourne Hospital is a comprehensive medical and surgical acute care facility serving the Brevard County Space Coast as a trusted healthcare provider since 2002. Conveniently located in Melbourne, the 119-bed hospital has all private rooms and is uniquely designed for your comfort and a positive patient experience. Our dedicated team of physicians, nurses, clinicians and medical professionals is committed to delivering the highest level of quality and compassionate care.

 

We provide a complete scope of care, with advanced technology and expertise in a number of specialties, including cardiovascular care, digestive health, emergency care, orthopedics and surgical services. Recognized for high standards, we have earned full hospital and laboratory accreditation from The Joint Commission, and we are the first hospital in Brevard County to receive spine surgery certification for our specialized spine program. The Joint Commission’s Gold Seal of Approval® distinguishes healthcare organizations and programs that exemplify their commitment to using best practices to improve safety and quality for their patients, staff and community. As part of our commitment to quality care, we also are a participant in the American College of Cardiology CathPCI Registry® for improved diagnostic cardiac catheterizations and percutaneous coronary interventions for heart patients.

WHY ORLANDO HEALTH?

Competitive Pay

Evening, nights, and weekend shift differentials offered for qualifying positions.

 

All Inclusive Benefits (Starting on 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

Orlando Health has been selected as one of the “Top Places to Work in Healthcare” by Becker’s Healthcare.

 

Company is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview

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.

Our people are passionate about what they do, the product they sell, and the customers they serve. If you're looking for an opportunity to be a part of a work family that values collaboration, innovation and dedication, we're the right company for you.

Section 1557 Non-Discrimination
The Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 42 U.S.C. 18116.

Responsibilities:

What you will do

• 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

Qualifications:

Qualifications

• 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.
• None