Care Management Technician - Insurance Verification and Referral

Position Summary

The Care Management Technician 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.

• 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.
• 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.