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

The Care Management Technician II in the Care Management department:

• Initiates and obtains 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
• 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.

✔ Education & Career Growth Assistance ✔ Comprehensive Health & Wellness coverage and resources  ✔ Financial & Retirement Planning with Company Match ✔ Excellent Company Culture and Work–Life Balance ✔ Family & Pet Support

..and more!

Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions.

• 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

• 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