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.
All the benefits and perks you need for you and your family:
- Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
- Paid Time Off from Day One
- 403-B Retirement Plan
- 4 Weeks 100% Paid Parental Leave
- Career Development
- Whole Person Well-being Resources
- Mental Health Resources and Support
- Pet Benefits
Schedule:
- Full time
- Shift: Day (United States of America)
- Address: 601 E Rollins St
- City: Orlando
- State: Florida
- Postal Code: 32803
Job Description:
- Monitor admissions and perform initial and continued stay medical necessity reviews.
- Maintain thorough knowledge of payer guidelines and regulatory requirements and manages concurrent and pre-bill denials to prevent loss of reimbursement.
- Collaborate and communicate with the multidisciplinary care team regarding patient status and concurrent denials.
- Build relationships to promote interdisciplinary collaboration.
- Ensure requested clinical information is communicated, monitors daily discharge reports, and follows up with insurance carriers to obtain complete authorization.
Knowledge, Skills, and Abilities:
- Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations.
- Demonstrates knowledge of the principles of growth, development, and disease states as it relates to the different life cycles.
- Ability to understand differences between notification, reference, and authorization numbers.
- Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.
- Accesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff.
Education:
- Associate's of Nursing [Required]
- Bachelor's of Nursing [Preferred]
Work Schedule:
- Weekend UM nurse; 4 -10hr days, 630am - 5pm or 7am - 530pm, templated schedule includes 5 out of 6 weekends per 6 week schedule rotation
Work Experience:
- 3+ years clinical nursing [Required]
- 5+ years clinical nursing in an acute care setting [Preferred]
- Experience working in electronic health records [Preferred]
- Utilization Management or Case Management [Preferred]
Licenses and Certifications:
- Registered Nurse (RN) [Required]
- Accredited Case Manager (ACM) [Preferred] OR Certified Case Manager (CCM) [Preferred]
Physical Requirements:
- (Please click the link below to view work requirements)
- Physical Requirements - https://tinyurl.com/msy4mja2
Pay Range:
- $68,806.40 - $120,723.20
Background Screening Requirement (Florida Law):
- Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.
- Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.