Utilization Management Manager - Utilization Management - Maitland at AdventHealth

Date Posted: 9/16/2019

Job Snapshot

  • Job Schedule
  • Location:
    Orlando, FL
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Family
    Other Clinical Professional
  • Travel
  • Shift
  • Application Zone
    2-Legacy System
  • Organization
    AdventHealth Central Florida

Job Description

Utilization Management Manager – Utilization Management– Maitland

Florida Hospital seeks to hire a Utilization Management Manager who will embrace our mission to extend the healing ministry of Christ.

Facility Profile:

Established in 1908, Florida Hospital is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. The Trickel Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel. The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.

Department Profile:

Under the guidance of the UM (Utilization Management) Director, the UM Clinical Supervisor assists the UM Manager in coordinating the AdventHealth Utilization Management program/plan across the Central Florida Division- South Region. Evaluates and monitors team’s performance and audits accounts for accuracy. Educates front line staff regarding errors, process changes, and payor updates. Serves as expert resource, educator, and liaison between Utilization Management and other revenue cycle and clinical departments. Assists the UM Director and UM Manager in providing day-to-day operational oversight to Utilization Management activities as needed and assists with aligning UM processes and goals with denial prevention. Serves as a mentor and role model to front line staff as well as subject matter expert supporting the UM Manager at interdisciplinary meetings. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

Work Hours/Shifts:

M-F, 8a-5p

Job Summary:

With general guidance, manages the daily operations of the AdventHealth Utilization Management (UM) department across the system. The UM Manager assists the UM Director with aligning Case Management/Utilization Management processes and goals with Denial Management. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all

Knowledge, Skills, Education, & Experience Required:

  • Strong organization skills and effective oral and written communication skills, with the ability to articulate complex information to all levels of staff. Self-motivator, quick thinker and able to work independently.
  • Able to assist UM Director in staff development, HR issues, and evaluations
  • Proficient in Microsoft Office to include: Outlook, Word and Excel
  • Proficient in English for both written and verbal communication
  • Working knowledge of InterQual and/or Milliman
  • Ability to do Power Point presentations and Excel spreadsheets (Preferred)
  • Overall understanding of payer contracts and government/regulatory compliance (Preferred)
  • Understanding of the appeal process for managed care and government entities (Preferred)
  • Ability to give group presentations as the need warrants (Preferred)
  • RN with Bachelors degree in Nursing, Management or related healthcare field such as: healthcare management, risk management or social work.
  • Minimum of five (5) years experience in an acute clinical setting including, but not limited to, acute inpatient hospital, managed care, and/or Center for Medicare and Medicaid Services.
  • At least one (1) year of supervisory experience responsible for supervising employees and assisting in work flow throughput in either Case Management or Utilization Management departments.
  • Varied clinical experience including nursing in ED, ICU/CCU, OB and/or nursing administration position such as Nurse Manager or Assistant nurse manager. (Preferred)

Licensure, Certification, or Registration Required:

  • Current valid State of Florida or multi state license as a Registered Nurse
  • Additional certifications or experience in Risk Management, Case Management or other associated professional certifications (Preferred)

Job Responsibilities:

Demonstrates through behavior Florida Hospital’s Core Values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork as outlined in the organization’s Performance Excellence Program
  • Manages all Utilization Staff; performs yearly evaluations, interim evaluations, any disciplinary actions or any other HR related compliance activities.
  • Direct contact for Case Management for questions related to discharge planning, length of stay or escalation to the physicians for medical necessity reviews to ensure payment.
  • Acts as liaison between PFS and Utilization Management for questions, concerns and file reviews that drive A/R and reimbursement. Participates in Florida Hospital, Case Management and campus specific process improvement opportunities and projects in alignment with the annual Utilization Management plan.
  • Works closely with UM Director to determine action plans for department improvements, throughput of work and to enhance efficiencies.
  • Provides oversight for concurrent and retrospective reviews to support Florida Hospital Utilization Management Plan, LOS and capacity initiative, and all Denial Management/Denial avoidance opportunities including specific appeal processes.
  • Department liaison for any other revenue cycle issues that require UM review/involvement such as lab reviews for medical necessity, bed management for early admits or bed placement.
  • Works closely with Medical Director to resolve problems/review cases as needed to establish level of care and to resolve denial issues from payers.
  • Interacts with the Denial Specialist, Medicaid and Medicare supervisors and gives support/guidance as needed regarding case review, level of care, denials and reimbursement enhancement. Provides coverage support and performs case reviews as needed to complete work lists.
  • Attends meetings as deemed appropriate by the UM Director for representation of the department, education or to assist the UM Director in regard to time management.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Care Management Assistant opportunity with Maitland and apply online today.

Job Keywords:

Care Management Assistant, Customer Service

Position Location:  Maitland
Job:  Other Clinical Professional
Organization:  AdventHealth Central Florida
Primary Location:  US-FL-Orlando
Schedule:  Full-time
Shift:  Day
Job Level:  Staff / Associate
Education Level:  Bachelor's Degree
Travel:  No
Job Posting:  Aug 16, 2019, 7:05:48 AM

Location | Organization | Category | Job Function