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AdventHealth UM Clinical Supervisor – Utilization Management – Maitland in Maitland, Florida


UM Clinical Supervisor – Utilization Management – Maitland

Maitland seeks to hire UM Clinical Supervisor who will embrace our mission to extend the healing ministry of Christ.

Facility Profile:

Established in 1908, AdventHealth 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. .

Work Hours/Shifts:

Mon – Fri / 8a – 5p

Job Summary:

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.

Knowledge, Skills, Education, & Experience Required:

  • RN with bachelor’s degree in nursing, Management or related healthcare field such as: healthcare management or risk management

  • RN with bachelor’s degree in nursing, Management or related healthcare field such as: healthcare management or risk management

  • RN with bachelor’s degree in nursing, Management or related healthcare field such as: healthcare management or risk management

  • Proficient in time management with superior prioritization skills and the ability to work independently with limited supervision

  • Self-motivator and quick thinker who is proactive and results oriented

  • Skill to mentor and coach team members for optimal success

  • Responsive to ever-changing matrix of hospital needs and acts accordingly

  • Understanding of HIPAA privacy rules and ability to use discretion when discussing personnel/patient-related issues that are confidential in nature

  • Proficient in Microsoft Office to include: Outlook, Word and Excel

  • Current clinical knowledge and knowledge of payer guidelines, regulatory guidelines (federal and state) and national standards for medical necessity including InterQual® level of care criteria

  • Critical thinking and problem-solving skills regarding clinical review and criteria

  • Proficient in performance of basic math functions and communicates professionally and effectively in English, both verbally and in writing

  • Ability to use multiple computer programs/systems at once to perform required job functions in efficient manner

  • Ability to present with confidence and communicate processes and protocols clearly

  • Varied clinical experience including, but not limited to, ED, ICU, CCU (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 AdventHealth’s Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization’s Performance Excellence Program.

  • Supports UM staff daily and acts as a resource to the team for questions or issues that may arise. Accountable for day-to-day functions of assigned area, ensuring all patient accounts are verified and authorized in a timely manner with appropriate follow up for account completion. Identifies problems proactively for expedited resolution. Supports department and team by ensuring patients receive a clinical review through system protocols accurately and timely. As needed, contacts insurance companies to address complex and challenging cases. Provides timely and continual coverage of assigned work area to ensure all accounts are completed. Directly monitors and mentor’s team regarding compliance. Serves as resource and subject matter expert for UM.

  • Trains all new Utilization Management employees in basic functions of the UM department and in payer-specific rules and regulations. Supervises all new UM RN’s within the 90 days’ (or extended) probationary period and completes 90-day evaluations in association with the UM Manager. Produces and updates, with UM Director and Manager input, training materials on an ongoing basis. Presents written and verbal updates to the UM nurses/team to ensure they are fully prepared to perform their job requirements, including compliance issues, contract terms and regulatory issues.

  • Serves as first point of contact for initial communication with service partners and is the first stage of the escalation process to management. Accountable for maintaining a working relationship with all to ensure open communication. Communicates with all parties (i.e., staff, physicians, payers, etc.) in a helpful and courteous manner while extending exemplary professionalism. Anticipates and responds to inquiries and needs in an assertive, yet courteous manner. Responsible to stay in communication with leadership regarding all aspects of operations and staffing. Escalates unresolved challenges to next-level leadership in a timely manner and ensures prompt and appropriate resolution. Acts as a resource to other Revenue Cycle and Clinical departments for issues related to rules and regulations, status determinations, and level of care.

  • Actively participates in AdventHealth, UM, payer and regulatory process improvement opportunities and projects, including support of evidence-base practice initiatives, in alignment with the annual UM Program/Plan. Ensures review requirements for assigned payers, based on payer matrix, is understood and within compliance. Ensures integrity of patient accounts by working assigned reports and auditing team members’ accounts as directed by leadership. Communicates with team members and leadership the educational needs for improvement related to processes and work flows via email or team meetings. Promotes and contributes to a positive work environment by demonstrating a supportive learning and teaching attitude, being flexible and open to change, and being sensitive to department and organization needs.

  • Maintains awareness of UM departmental changes, standards, and goals and disseminates this information to the team in the UM department meetings, via e-mail or by printed materials given to the team. Ensures a high level of team productivity by reviewing daily reports for volume and type of review, daily bill hold reports, and offering additional assistance as required. Ensures team members are prioritizing accounts and addressing for timely account follow up and completion. Ensures team success in meeting and exceeding monthly department and Revenue Cycle goals. Runs / schedules reports and distributes to appropriate staff ensuring team members always have work needed and management is kept apprised of issues in performance or processes in a timely manner.

  • Documents employee performance and attendance. In conjunction with the UM Manager, assists with input into the annual evaluations of the UM RN’s.

  • Participates in payer meetings/teleconferences/seminars as required to remain current in all legislative updates/changes or any issues regarding Medicare/Medicaid that affects reimbursement. Ensures compliance with state, federal, and contract payer rules, including Medicare Conditions of Participation.

  • Works on special projects as deemed appropriate by the UM Director and Manager based on departmental needs or requirements. Accompanies management to interdepartmental meetings to present and advise as needed. Adheres to HIPAA regulations. Other duties, as assigned, based upon business objectives as outlined by the Director.

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 UM Clinical Supervisor opportunity with Maitland and apply online today.

Job Keywords:

UM Clinical Supervisor, Maitland

Job: Other Clinical Professional

Primary Location: US-FL-Maitland

Position Location Maitland

Organization AdventHealth Central Florida

Schedule Full-time

Shift Day

Job Level Team Leader

Education Level Bachelor's Degree

Travel No

Job Posting May 16, 2019, 3:03:12 PM

Req ID: 280469

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.