Working at
Health System One

Careers

At HS1 Medical Management we believe that employees are our most valued assets.  Attracting and retaining outstanding individuals is the key to our long-term success as leaders in the healthcare industry.

We would be pleased to discuss all of the benefits associated with employment at HS1 Medical Management with you.  Feel free to contact an HS1 Human Resource Representative in the event that you have any comments or questions or if we may be of assistance in any other way.

Reasons to Join HS1

Your career is an important part of your life. You want to choose the right employer. There are many reasons to join the Health System One team.

We’re guided by core values

It makes a big difference in your work day when you know that management, your coworkers and you all have the same goals and values. We put the people who use our services at the center of everything we do.

We care about our employees

From competitive benefits to a positive work environment, we strive to help our employees succeed in and out of the office.

To submit your resume, please send it to:

hr@healthsystemone.com

HS1 Medical Management is an Equal Opportunity Employer.

Current Openings

Utilization Management Team Leader (Fort Lauderdale — 3/20/17)

Summary: This position is responsible for assuring that all clients’ patients and providers’ needs are met by receiving phone calls from both members and phone calls and faxed referrals from providers. Activities implemented are to facilitate the authorization and coordination of referrals utilizing pre-approved screening criteria in compliance with contracted Client's requirements. Team leader has to be a competent, knowledgeable resource for information. Under the direction of the Utilization Management Director, supervises the Coordinators and provides them with leadership to ensure high quality results.

Essential Functions & Responsibilities:

  • Assures that UM authorization coordinators are available to receive phone calls and faxed referral requests from providers. Assists UM authorization coordinators with phone calls and referral requests as necessary. Is resource person for all coordinators for all clients’ utilization management activities.
  • Monitors incoming faxes and distributes work among the authorization coordinators.
  • Is liaison between providers and UM authorization department, trouble shoots any problems arising in UM Authorization process and reports to supervisor as well as to appropriate departments.
  • Assists with compiling monthly utilization management statistics.
  • Reviews monthly phone statistics and phone criteria with Director of Utilization and comes up with corrective action plan as necessary.
  • Assists with quarterly inter-rater reliability reports of non-clinical UM staff.
  • Assures that authorization coordinators are in-serviced on all various clients’ products.
  • Ensures that departmental and organization goals are met.
  • Ensures that Coordinator meet productivity requirements.
  • Identify and facilitates training needs on Coordinators.
  • Ensures that all requests are timely processed.
  • Ensures that Coordinators maintain a professional and productive behavior.
  • Ensures that daily reports are timely monitored.
  • Makes sure all authorization coordinators are instructed and well versed in the following duties:
    • Verification of member eligibility and benefits for client plans.
    • Inputs all referral requests including ICD-9 and CPT codes into system accurately for electronically generated authorization tracking.
    • Provides referral authorization to external providers per UM Departmental Policy and Procedures and specific contracted Client's process.
    • Requests submission of appropriate medical records according to established criteria for requested service(s).
    • Issues authorization within appropriate timeframe for routine, urgent and emergent requests.
    • Appropriately forwards all referral requests to the next level of review.
    • Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.
    • Coordinates approved services with Home Health Providers, Plan discharge Planners and Plan Members as delegated or required by Plan
    • Is resource person for PCP to refer to network specialist(s).
    • Distributes correspondence and other information to the appropriate parties or departments.
    • Maintains appropriate logs, records, and reports as established by Utilization Department.
    • Documents and communicates areas of concern to supervisor.
    • Identifies providers who are problematic with plan requirements.
    • Adheres to company HIPAA policies and procedures.
    • Ensures integrity of data entry is accurate
  • Add your content...Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Compliance with all personnel policies and procedures.
  • Perform additional duties and related essential duties as assigned.

UM Compliance Auditor (Fort Lauderdale — 3/20/17)

Summary: The overall responsibility of the UM Compliance Auditor is to implement an ongoing monitoring program of the UM Department based on documented UM Policies/Procedures, Program Description and the organization’s overall Compliance Plan. The UM Compliance Auditor, under the guidance of the UM leadership, will establish UM performance benchmarks and/or goals that reflect applicable contract terms, regulatory standards (state/federal), as well as accreditation/certification guidelines.

The UM Compliance Auditor will interface with the organization’s Compliance Team and serve as the liaison between UM and Compliance. This collaboration will ensure that low/non-compliant items are quickly identified and clearly documented, that issues are adequately communicated to appropriate parties, and that corrective measures are outlined in accordance with industry standards.

This position will be essential in resolving audit-related issues by researching, monitoring, and reporting compliance findings and participating in the development and implementation of new or updates to Utilization Management protocols and standards.

Essential Functions & Responsibilities:

  • Develop a tracking system for internal auditing of UM functions and maintain audit records and data (hard copies and in database)
  • Demonstrate knowledge of state and federal, managed care, and commercial policies by communicating all contractual and regulatory updates to UM leadership and staff
  • Collaborate with Corporate Compliance in the assessment of all new and amended contracts and the investigation and resolution of compliance issues
  • Assist with the development and implementation of departmental quality standards and measures to improve performance
  • Analyze audit findings to identify performance trends, areas of re-training for staff, and communicate findings to UM leadership
  • Monitor UM staff performance for compliance adherence and thoroughly documents all findings for the development of corrective action plans
  • Collaborate with UM Supervisors and Team Leads for the implementation of corrective action plans and perform follow-up reviews to determine their effectiveness; provide coaching recommendations as needed
  • Prepare accurate and timely reports easily understood by both clinical and non clinical technical and non-technical audience
  • Periodically evaluate the status of UM policies and recommend improvements
  • Adhere to departmental standards, policies, protocols
  • Actively participate in team meetings and work groups

Required Education and Experience:

  • Bachelor's degree (B. A.) from four-year College or University
  • Minimum of Two (2) years prior managed healthcare/HMO experience in Utilization Management, Program (Medicare or Medicaid) Operations, Compliance and/or other related oversight/audit fields
  • Minimum 1 year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations
  • Intermediate analytical skills and an understanding of operational processes and regulatory requirements a must
  • Demonstrated strong written and oral communication, and presentation skill a must
  • Prior experience with Medicare and Florida Medicaid programs strongly preferred
  • Prior project oversight type role with demonstrated ability to drive implementation and influence others is a plus
  • Demonstrated knowledge of ICD-10, CPT Codes, and medical terminology

Utilization Management Trainer (Fort Lauderdale — 3/20/17)

Summary: Responsible for the training of all UM personnel to ensure compliance with policies and procedures. To ensure that protocols are followed with regard to provider contracts, member benefit schedules, established guidelines, and departmental policies and procedures. Develop employee on-boarding training programs as well as on-going skills training for technological updates or other operational changes, plan, coordinate and conduct training exercises.

Essential Duties & Responsibilities:

  • Training and guidance to the UM Department Staff on their daily responsibilities in the department for quality and productivity purposes.
  • Confer with management, supervisors and employees to gain knowledge of work situations requiring training and to better understand changes in policies, procedures, regulations, business initiatives and technologies.
  • Coordinate training schedule with the hiring and training demands of department.
  • Participates in, and conducts technical training programs. Determines training objectives.
  • In collaboration with the department management, writes training programs, including outline, text, handouts, Manuals and post-tests, and designs laboratory exercises to measure that learning objectives are met or identifies new training needs as applicable.
  • Conducts training sessions covering specified areas such as on the job training, refresher training, etcetera.
  • Test trainees to measure progress and to evaluate effectiveness of training.
  • Report on progress of employees under guidance during training periods, assist employees with problems concerning “how to” perform specific tasks. Make suggestions on improving work procedures.
  • Develop strong relationships with all UM Coordinators, Team Leaders and UM Management.
  • Performs periodic reviews of authorization to identify training needs of individuals and team in general.
  • Administers written and practical exams and writes performance reports to evaluate trainees' performance.
  • Creates, maintains, and upholds the weekly, monthly & annual audit reports of the UM staff performance to UM management.
  • Review, process and adjust referrals as needed
  • Support UM Coordinators on the pending referral requests
  • Coordinates with Team Leaders and UM management and conducts in-service sessions to the UM staff in order to address departmental processes.
  • Recognizes referral issues/problems, refers them to management and/or appropriate party and assists in the review and implementation of resolution.
  • Assists management and all staff in their daily work as needed or necessary.

PT UM Reviewer - FL PT Licence (Fort Lauderdale — 3/20/17)

Summary: Responsible for clinically reviewing request for PT services in a timely manner utilizing established clinical guidelines and Utilization Management protocols to evaluate for the medical necessity and appropriateness of the requested PT services. Responsible for making favorable organization determination and escalating cases deemed not medically necessary to the Medical Director. Performs Peer to Peer discussions with requesting provider

Essential Functions & Responsibilities:

  • Clinically reviews requests for PT services and submitted by the Coordinator who prepares the cade for review. Reviews supporting clinical information: Evaluation, Plan of Care with standardized test scores, and Progress Notes in timely manner.
  • Determines if services are medically necessary and if the Plan of Care is appropriate for treatment modality. Length, intensity and frequency. Clinical decisions are made following nationally recognized clinical guidelines and Utilization Management protocols in place.
  • Documents determination and provides a clinical report identifying instances where a provider shows a trend and educational opportunity.
  • Is available for Peer to Peer Consultation with any therapist upon request or when a Plan of Care does not follow appropriateness according to clinical guidelines before submitting the case to the Medical Director for final review, and determination.
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Compliance with all personnel policies and procedures.
  • Perform additional duties and related essential duties as assigned.

Required Education and Experience:

  • Licensed Physical Therapist
  • Licensed Physical Therapist. Minimum of 5 years of clinical experience in a medical/hospital/clinic setting.
  • Managed care experience preferred

Certificates, Licenses, Registrations:

Licensed Physical Therapist in the State of Florida

Project Management Specialist (Fort Lauderdale — 3/20/17)

Summary: The Project Management Specialist is responsible for the day-to-day departmental project management, project implementation, workflows and research coordination necessary to meet project timelines requirements within the Utilization Management Department. They must have a strong understanding of process mapping/planning, departmental goals and objectives to ensure successful execution and delivery of assigned projects.

The PM Specialist works with a high degree of autonomy, demonstrates strong analytic and problem-solving skills, is highly organized and must be mission-driven with a can-do attitude. The PM Specialist must be able to work in a fast-paced environment with the ability to think quickly and successfully handle multiple tasks simultaneously, prioritize effectively while adapting to shifting deadlines and priorities. Working closely with internal staff and management the primary responsibility is to ensure that departmental tasks are completed on schedule and that the final product meets the business, technical standards and policies of the Organization.

Essential Functions & Responsibilities:

  • Enhance existing workflow, documentation and procedures
  • Utilization and support of cloud-based collaboration software platform
  • Promote quality assurance against project deliverables to ensure they meet project objectives/requirements
  • Develop communications and coordinate project logistics
  • Develop spreadsheets as necessary for tracking project status
  • Develops and maintains relationship and effective communication with staff in order to facilitate problem identification and resolution
  • Coordinates collection of data monitoring, assessment and measure of organizational performance by use of aggregate data, analysis and reports this along with recommendations to management
  • Assists in the management of the daily operations and functions of the Utilization Management Department
  • Reviews production schedules along with work progress and works with UM Management to make corrective actions to meet production/profit goals.
  • Drive deliverables, troubleshoot issues, and when required perform root cause analysis for continuous process improvement.
  • Skill in analyzing information, problems, situations and procedures to define the problem or objective, identify relevant concerns or factors and formulate logical and objective conclusions.
  • Exceptionally strong organizational and time management skills; proven ability to set priorities which accurately reflect the relative importance of job responsibilities and take into consideration deadlines, competing requirements and complexity.
  • Facilitating project teams, including scheduling, agenda preparation, meeting set up and follow up
  • Managing the complex projects by creating and managing work plans and timelines. Delivers on deadlines.
  • Preparing and delivering written and verbal presentations to work teams and leadership groups
  • Collaborating with clinical and operational leaders to develop, design, describe, deploy, and deliver improvement initiatives
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Compliance with all personnel policies and procedures.

Authorization Coordinator (Fort Lauderdale — 3/20/17)

Summary: This position is responsible for servicing the needs of patients by receiving phone calls from both members and referrals from providers to facilitate the authorization and coordination of referrals utilizing pre-approved screening criteria in compliance with contracted Client's requirements.

Essential Duties and Responsibilities:

  • Receives phone calls and faxed referral requests from providers.
  • Verifies member eligibility and benefits.
  • Inputs all referral requests including ICD-10 and CPT codes into system accurately for electronically generated authorization tracking.
  • Provides referral authorization to external providers per UM Departmental Policy and Procedures and specific contracted Client's process.
  • Requests submission of appropriate medical records according to established criteria for requested service(s).
  • Issues authorization within appropriate timeframe for routine, urgent and emergent requests.
  • Appropriately forwards all referral requests to the next level of review.
  • Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.
  • Coordinates approved services with Home Health Providers, Plan discharge Planners and Plan Members as delegated or required by Plan.
  • Is resource person for PCP to refer to network specialist(s).
  • Compiles monthly departmental statistics.
  • Distributes correspondence and other information to the appropriate parties or departments.
  • Maintains appropriate logs, records, and reports as established by Utilization Department.
  • Documents and communicates areas of concern to supervisor.
  • Identifies providers who are problematic with plan requirements.
  • Adheres to company HIPAA policies and procedures.
  • Ensures integrity of data entry is accurate.

Required Education/Experience/Skills:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
  • High school diploma or general education degree (GED); Medical coding or authorization education/training preferred.
  • Two years related experience needed.
  • Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
  • Ability to write routine reports and correspondence.
  • Ability to speak effectively before groups of customers or employees of organization.
  • Good verbal skills including good diction and grammar.
  • Ability to speak fluent English and Spanish.
  • Ability to communicate effectively and accurately over the telephone.
  • Must have good customer service skills
  • Ability to use cross reference guidelines
  • Medical terminology skills
  • Preference will be given to medical assistants, certified nursing assistants and allied medical professionals.