All the benefits and perks you need for you and your family:

• Benefits from Day One

• Paid Days Off from Day One

• Student Loan Repayment Program

• Career Development

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule:Full Time

Shift: Monday- Friday 8a- 4:30pm

Location:Fully Remote

The community you’ll be caring for: AdventHealth West Florida Division

• Rollover PDO with service year increases in accrual

• Comprehensive benefits package; including tuition reimbursement and matching 403b plan

• Patient facing positions receiving company paid initial sets of scrubs

• Company Discount programs

• Growing Organization

• Reimbursement for clinical position certifications

The role you’ll contribute:

The Utilization Management (UM) Specialist works under the direction of the Utilization Management Manager and supports the Utilization Management team with Emergency, Observation and Inpatient visits. The UM Specialist is responsible for providing clerical assistance to the Utilization Management Nurses (UM RN) to assist with verification of benefits, authorization procurement and other assigned tasks as needed. The UM Specialist is responsible for collaborating with the UM RN and other members of the interdisciplinary team (i.e. Physicians, Care Managers, Social Workers, etc.) or interdependent departments (i.e. Patient Access, Billing, etc.) to ensure unnecessary delays in patient care, discharge or billing.

The UM Specialist will serve as the first point of escalation for payors requiring assistance in gaining additional or missing information to support authorization. The UM Specialist will be responsible for ensuring procurement of authorization upon admission and discharge as well as, accuracy of authorization information. The UM Specialist will ensure timely escalation of barriers to authorization requiring clinical expertise and assist in coordination of Peer to Peer discussions with the payor.

The value you’ll bring to the team:

• Coordinates and supports clerical and administrative activities of the Utilization Management team

• Collaborates and communicates with payor via phone, fax or payor portal

• Submits clinical reviews to payors

• Provides information to payors supporting admission /continued stay

• Manages requests submitted from payors

• Provides discharge dates to payors

• Submits copies of UM activities to payors, as needed

• Tracks and monitors requests through EMR

The expertise and experiences you’ll need to succeed:

• High School diploma or GED

• Two (2) years’ experience in Patient Access, Revenue Cycle Operations, Pre-Access, or related department