Utilization Management Specialist
On-siteTampa, Florida, United States
Tampa, Florida, United StatesOn-siteFull Time
Full Time
Job Summary
Prepare initial authorizations for Medicaid-funded services and process invoices from providers to ensure timely initiation of care for children and families. Serve as the central point of contact for case managers, tracking referrals for Comprehensive Behavioral Assessments and processing service authorizations upon approval. Cultivate relationships with network providers while maintaining accurate client records of service requests, payments, and level of care changes. Monitor daily email to circulate pertinent information to unit staff and collaborate with co-workers to streamline processes and maintain unit efficiency. Perform required field-based activities, including driving and traveling within and outside Hillsborough County, while adhering to standard business hours with occasional evening or weekend work as needed.
Required Qualifications
- Bachelor's degree (B.A.) from a four-year accredited college or university
- Florida Child Welfare Certification (Case Management or Investigations)
- Minimum of one (1) year of experience in Child Welfare, social services, behavioral health care, or related field
- Excellent organizational and problem-solving skills
- Self-motivated with the ability to manage various work assignments simultaneously
- Ability to establish and maintain positive working relationships with others
- Ability to read, analyze, and interpret common scientific and technical journals, financial reports, legal documents, and/or governmental regulations
- Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community
- Ability to write speeches and articles for publication that conform to prescribed style and format
- Ability to effectively present information and respond to questions from groups of managers, clients, public groups, and/or boards of directors
- Ability to speak effectively before groups of customers or employees
- Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals
- Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
- Ability to define problems, collect data, establish facts, and draw valid conclusions
- Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
- Ability to be proactive, as well as handle problems involving several concrete variables in standardized situations
- Ability to sit for extended periods
- Ability to walk
- Ability to stand
- Ability to use hands to finger, handle or feel
- Ability to reach with hands and arms
- Ability to stoop, kneel or crouch
- Ability to talk and hear
- Visual acuity sufficient to read and to operate standard modern office machines
- Ability to occasionally lift and/or move up to 25 pounds
- Must be able to drive and have reliable transportation to perform required field based activities
- Valid driver's license required, with proof of insurance
- Driver's license check is a requirement
- Criminal background screening (fingerprinting) (Local Law Enforcement and FBI/FDLE)
- Drug Screening is a requirement
- Children's Network participates in E-Verify
- Must abide by the highest standards of confidentiality
- Must be able to operate standard modern office machinery, including fax, telephone, calculator, computer, scanner, printer, copier and mail machine
- Minimum typing speed of 45 wpm
- Excellent word processing skills
- Must be competent with Microsoft Office Suite programs, including Word, Excel, Power Point, Access, Publisher and Outlook
- Must be competent with basic e-mail protocol and procedures including sending, receiving, replying, attachments, and meeting scheduling
- Excellent written and oral communication skills
- Effective listening skills
- Ability to work as a team member
- Ability to work in a multi-cultural environment
- Must maintain regular in-office attendance when not performing required field-based duties
- Must be able to collaborate effectively with team members
- Must be able to participate in meetings with internal and external stakeholders
- Must be able to access agency resources and systems
- Must be able to provide timely support for agency operations and service delivery
- Must be able to work hours outside of standard hours, including evenings and weekends, as needed to meet operational demands
- Must be able to travel within and outside of Hillsborough County
- Must be able to complete fifteen (15) hours of training annually
- Must ensure that all training and continuing education requirements are met to maintain their credential or licensure
Desired Qualifications
- Knowledge of local community services is desired
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