Care Management Technician II - Case Management - Bayfront Hospital - St Pe at Bayfront Health

Saint Petersburg, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

31 Jul, 26

Salary

0.0

Posted On

02 May, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Authorization, Case Management, Post-acute Care, Medical Necessity, Chart Review, Clinical Documentation, Payer Portal Functionality, Critical Thinking, Communication, Microsoft Software, Interpersonal Skills, Referral Management, Patient Assessment, Regulatory Compliance

Industry

Hospitals and Health Care

Description

Position Summary Overview: Title: Care Management Technician II Department: Case Management – Acute Care Site: Orlando Health Bayfront Hospital Location: St. Petersburg FL Position Summary: The Care Management Technician II in the Care Management department: Initiates and obtains 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 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. About the organization:Orlando Health Bayfront Hospital is a comprehensive tertiary care facility that has been serving St. Petersburg and the surrounding communities for more than 100 years. It is a 480-bed teaching medical center with nationally recognized care across emergency medicine, cardiology, neurosurgery, orthopedics, women’s services, and advanced surgical specialties. The hospital’s Level II Trauma Center is the only adult trauma center in Pinellas County and, in partnership with Johns Hopkins All Children’s Hospital, is one of Florida’s 13 state-certified Level III Regional Perinatal Intensive Care Centers. A commitment to quality has earned the hospital recognition with a USA Today Top Workplaces award for 2025 and an “A” Hospital Safety Grade for Spring 2025 from The Leapfrog Group.Orlando Health Bayfront Hospital is part of the Orlando Health system of care, which includes award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities that span Florida’s east to west coasts. As part of the Orlando Health system, Bayfront combines the resources of a leading regional healthcare network with the personalized, community‑focused care that has defined the hospital for generations.Why Orlando Health is your best place to work: ✔ Education & Career Growth Assistance ✔ Comprehensive Health & Wellness coverage and resources ✔ Financial & Retirement Planning with Company Match ✔ Excellent Company Culture and Work–Life Balance ✔ Family & Pet Support ..and more! Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions. Responsibilities Essential Functions: 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. 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. Performs all other duties as assigned Qualifications Education/Training: 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. Experience: Two years’ experience in post-acute insurance authorization OR associate’s degree in healthcare field with one year of experience in post-acute referral management OR One year of experience in post-acute insurance authorization

Responsibilities

The Care Management Technician II initiates and obtains insurance authorizations for post-acute services while collaborating with the care team to ensure patient needs are met. They are responsible for identifying medical criteria through chart reviews and developing clinical packets to justify required levels of care.