Utilization Management Specialist, Brooks Rehabilitation Hospital
Brooks Rehabilitation
 Jacksonville, FL

Overview

Reporting to the VP of Operations, the Utilization Management Specialist has the responsibility for working with the case management and medical teams to ensure judicious use of the facility resources and high quality care. A successful utilization management specialist is organized, assertive, creative, and a great communicator.

Responsibilities

  • Monitoring and management of health benefit plans
  • Ensuring proper utilization of resources while ensuring patients receive the care they need
  • Interfaces with interdisciplinary team about utilization challenges and expectations
  • Creatively addresses barriers to discharge with clinical teams
  • Work with interdisciplinary team to ensure discharge spread
  • Gathers and analyzes data of utilization including but not limited to LOS, cost, and insurance plans
  • Develops solutions for utilization opportunities
  • Educates medical staff on utilization trends and solutions
  • Manages, prepares, sends, and tracks all insurance continuation of stay authorizations
  • Schedules and prepares all peer to peer assessments
  • Prepares and writes all appeals
  • Maintains documentation requirements
  • Completes chart audits
  • Responsible for providing a positive patient experience through compassion and communication

Qualifications

  • Bachelor's Degree in clinical specialty, hospital/healthcare administration, business, or other related field
  • Nursing degree preferred
  • Three year experience in healthcare field at minimum
  • Effective communication
  • Excellent organizational skills
  • Ability to problem solve
  • Computer proficiency
  • Compassion

Location : Name

Brooks Rehabilitation HospitaL_ 0028

Type

Full-Time

Hours

Monday - Friday 8am - 5pm