At FOI our goal is to provide our patients with world-class orthopedic care.

Our mission of providing the best care encompasses not only the care the physician provides, but all medical and administrative aspects of the patients encounter with Florida Orthopaedic Institute (FOI) as well. Every staff member plays a vital role in this mission. We take pride in receiving the Patriot Award from the Department of Defense for the support that we give to National Guard and Reserve members who are employed by FOI. We are committed to encouraging a culture of inclusion reflective of the communities we serve, and we provide equal opportunity to all. Florida Orthopaedic Institute conforms to the spirit as well as to the letter of all applicable laws and regulations.

What we offer:

• Full time opportunities available, with room for career growth and advancement.
• Excellent job security and stability, to promote an optimal work life balance.
• Be part of this dynamic and growing high level Patient Services team!

Position is a in office-based position.

In this role you will:

Be responsible to oversee the workflow of the pre-certification staff as well as coaching, resolving issues and serving as a link between subordinates and upper management. You will also be responsible for preforming 1st level peer to peer requests with insurance carriers to reduce the burdensome tasks of peer to peer from the physicians.

Key Responsibilities:

• Monitor assigned work volume and adjust staff activity to maximize surgical authorization completion timeframe.
• Participate in development and continuous improvement of staff efficiency.
• Monitors effective of peer to peer and denial management of surgical cases.
• Provide leadership and guidance.
• Develops, establishes and implements the departmental policies and procedures.
• Oversees the training of the Pre-Cert Counselors.
• Assists with training new/established Pre-Cert Counselors.
• Maintain and update the employee Share Point site for the Pre-Certification Department.
• Conduct department meetings related to updating or changing information. To be performed in conjunction with weekly staff meetings.
• Conduct evaluations, counseling on employee’s performance, ensuring that all employees are properly trained.
• Create and maintains training materials.
• Collaborate with Team Leads within the Precert Department.
• Conducting interviews with potentials candidates when applicable.
• Communicate effectively with staff, physicians and administration.
• Completion of % assigned pre-certification cases daily.
• To utilize all accessible resources to achieve goals
• Monitor 3rd party assisting company with work volume in queue for any cases that need to be worked by our department and push appropriate accounts.
• Work directly with Manger/Director to discuss process and changes in the department and communicate with the manager any problems or issues of concern within the department.
• Cover staff and/or lead duties in any absences.
• Responsible for all weekly daily Athena reporting.
• Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies and approve services or forward request to the appropriate physician or medical director with recommendations to other determinations.
• Ensure that the department staff are applying the appropriate application of policies and guidelines to prior authorization requests.
• Assist Director and Manager with the creation of resources to non-clinical and clinical team staff.
• Perform 1st level peer to peer requests with insurance carriers to reduce the burdensome tasks of peer to peer from the physicians.
• Completes and maintains staff and department statics.
• Assure compliance with all company plans, policies and procedures set forth by the Florida Orthopaedic Institute
• All other duties as assigned.

About You:

• Must have a RN, LPN or Case Manager license
• Must have a minimum of 2-5 years supervisor experience.
• Knowledge of utilization management standards.
• Must be dependable, flexible, detail oriented, multi-tasked, organized, and a self-motivated individual.
• Excellent verbal and written communication skills
• Working knowledge of Microsoft Office
• Effectively deliver quality patient care and follow through with physician orders
• Excellent communication skills
• Strong interpersonal skills
• Willingness to work a flexible schedule based off practice needs

We Would Love It If You Also Had:

• Athena EMR experience
• Surgical scheduling experience.
• Prior surgical pre-authorization experience a plus