Monday, Tuesday, Wednesday, Thursday, Friday
7am to 7pm
Submission for the position: Utilization Management Associate 2 - (Job Number: 21000321)
https://tgh.taleo.net/careersection/jobdetail.ftl?job=21000321&lang=en
Utilization Management Associate 2
Facility Profile
TGH is the area’s only level I trauma center and one of just two ABA-verified adult & pediatric burn centers in Florida. With five medical helicopters*, we transport critically injured or ill patients from 23 surrounding counties to receive the advanced care they need. The hospital is home to one of the busiest solid organ transplant centers in the country. TGH is a nationally designated comprehensive stroke center, and has a 32-bed Neuroscience Intensive Care Unit.  Other outstanding centers include cardiovascular, orthopedics, high-risk and normal obstetrics, urology, ENT, endocrinology, and the Children’s Medical Center, which features a nine-bed pediatric intensive care unit and pediatric kidney transplant services. As the region’s leading safety net hospital, Tampa General is committed to providing area residents with world-class and compassionate health care ranging from the simplest to the most complex medical services.
Tampa General Hospital was named the #1 hospital in Tampa Bay by U.S. News & World Report, 2020-2021, and recognized as one of America's Best Hospital's in five medical specialties: Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology & GI Surgery, Nephrology, and Orthopedics. Tampa General Hospital has been designated a Magnet Hospital by the American Nurses Credentialing Center (ANCC), the highest recognition for nursing excellence, for the fourth consecutive time – an accomplishment that fewer than one percent of hospitals nationwide have earned. TGH is accredited by The Joint Commission and was awarded disease-specific certification in five medical specialties. TGH is also accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). *Air transport provided by Metro Aviation, Inc.
Department Profile
Tampa General Hospital’s Revenue Cycle department delivers comprehensive administrative and clinical services and comprises of four departments – Patient Accounts, Health Information Management, Patient Access, and CDI/Coding. The Patient Accounts Department is a segment of the revenue cycle, responsible for the billing of hospital and professional claims to insurance carriers. The Health Information Management department at Tampa General Hospital is the guard of the electronic health record, collaborating with contributors and customers of health information that include the Medical Staff, Clinical Operations, Information Technology and Finance. While the physicians, nurse and health care team are taking care of patients and loved ones, Health Information Management professionals are the ones taking care of patients' health information— ensuring it is captured, complete, accurate, protected and made available when needed.  Patient Access provides scheduling services to all TGMG locations, radiology locations and other ancillary services. Financial clearance teams ensure scheduled services are authorized for all service lines.  Patient access teams are positioned throughout Tampa General Hospital and in the TGH Emergency Department, TGH Brandon Healthplex, and Rehabilitation locations. The call center is located at the WFLA News Station in downtown Tampa.
Job Summary
Assists Care Coordinators and Social Workers in achieving the goals of the Case Management department through the successful completion of utilization review, including but not limited to, (1) admission and continued stay reviews, payer communication, certification and authorization, (2) concurrent denial management, (3) timely delivery, documentation, and tracking of “Important Message” notices to Medicare patient or representative, (4) provision of complete clinical information to a continuum of post-acute care providers including follow up with providers to ensure information was received and is complete, and (5) coordination of facility placements, transportation, home healthcare and other community support services that ensure a safe and appropriate patient discharge, and prevent re-hospitalization. Explains discharge process to patients or representatives. Offers choice of post-acute care providers. Utilizes department tools and resources to organize and prioritize case load and competing priorities. Supports the efforts of HIM and Patient Accounts by ensuring timely, accurate, and complete data entry in multiple information systems/data bases. Brings workflow barriers or issues to the attention of the Utilization Management Associate Supervisor in an expedient manner. Maintains excellent working relationships with primary care providers, payers and post-acute providers. Ensures that flow of information, including delays, to Care Coordinators and Social Workers is timely, appropriate, and accurate. Must possess strong organizational skills and be able to work in a fast paced environment. Demonstrates ability to multitask and exhibits attention to detail. Responsible for performing job duties in accordance with the mission, vision and values of Tampa General Hospital.
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Associate’s degree in Social Work or related area of study preferred.
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Three years’ experience in utilization management and hospital case management/ social service and/or managed care performing discharge planning, interfacing with insurance companies and/or utilization review may substitute for the degree.
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Medical terminology required.
TGH Corporate Center (TGHCORPCTR)
606 w. Kennedy Blvd.
Tampa , 33606
TGH Main Campus (TGHMAIN)
1 Tampa General Circle
Tampa , 33606
TGH Corporate Center
606 w. Kennedy Blvd.
Quality/Utilization Management
TGH - Hospital
Oct 21, 2021, 11:19:04 AM
Schedule: Full-time Location(s): Tampa Day Job