HCA, Hospital Corporation of America Utilization Management Coordinator in Gainesville, Florida
North Florida Regional Healthcareis an organization centered around the community hospitals in Gainesville, Florida -- North Florida Regional Medical Center (NFRMC) and Lake City Medical Center (LCMC). NFRMC is a 432-bed, full-service medical and surgical acute care center serving North Central Florida and offering comprehensivecardiovascular care,oncology,orthopedics,neurosciences,minimally-invasive laparoscopic and robotic surgery,weight loss surgery and treatment,women’s healthandwound therapy, among other services. A proven leader, NFRMC is fully accredited, is certified as a Primary Stroke Center and a Quality Top Performer by The Joint Commission in four consecutive years, is an accredited Chest Pain Center, is designated as a Blue Distinction™ Center for Knee and Hip Replacement, Spine Surgery and Bariatric Surgery and recognized by U.S. News & World Report for its High-Performing Gynecology Program in 2010.
POSITION SUMMARY: The Utilization Management Coordinator (“UMC”) demonstrates critical thinking skills, and is able to work independently using good judgement at all times. The UMC will work as an integral part of the Behavioral Health Unit team playing a vital role in assisting with the coordination of care for patients while working to maximize appropriate reimbursement to NFRMC for the patient’s care. The UMC will conduct themselves within the Code of Conduct and will follow all policies and procedures of North Florida Regional Medical Center.
ESSENTIAL FUNCTIONS: * Demonstrates advanced level of clinical knowledge related to the treatment of behavioral health patients. * Oversees the Intake process including the orientation of new Intake Assessment Evaluators. * Audits the intake process and provides reports monthly and/or as needed. * Remains current in InterQual training. * Participates as a member of the North Florida Division Denials mitigation team as a representative of the NFRMC BHU. * Validates and documents receipt of third party payer authorizations on or prior to admission. * Completes all post-admission third party payer requirements. * Completes all utilization review requirements necessary to successfully obtain stay extensions. * Assists with the completion on any and all reports as assigned. * Participates in the team process as the team specialist on third party payer matters including offering suggestions for appropriate documentation needs and improvement. * Works diligently to reduce and maintain a very low volume of escalations to peer review for stay extensions. * Actively seeks ways to reduce unreimbursed care without compromising patient safety, quality of care or the services delivered. * Attends in-service presentations and completes all mandatory education requirements. * Orients and trains other assigned staff to complete the UM functions when on PTO. * Participates a crisis prevention intervention trained staff member.
EDUCATION REQUIRED AND/OR PREFERRED: * Master Level Degree with appropriate full licensure as LMHC, or LCSW. * Associate Degree, Diploma in Nursing, or BSN required LICENSURE/CERTIFICATION: * LMHC * LCSW * State of Florida RN License required if RN *EXPERIENCE REQUIRED OR PREFERRED: * * Acute care experience required An EEO/AA Employer M/F/V/D. Tobacco Free Campus
Title: Utilization Management Coordinator
Location: Florida-Gainesville-North Florida Regional Medical Center
Requisition ID: 00039-11998