Teams at Franciscan Health

Perform concurrent utilization reviews and admission screenings to determine medical necessity and appropriate care setting. Communicate with physicians, patients, payors, and internal teams regarding admissions, length of stay, denials/appeals, and letters. Provide education and act as a case management resource on payer rules, policies, and utilization criteria.

Manage and process complex medical and billing record release requests in compliance with HIPAA and organizational policies. Coordinate with Legal and Risk, maintain Epic requestor database and ROI forms, release records via multiple methods, support billing for records, troubleshoot documentation issues, and serve as departmental ROI resource.

Manage the Epic EHR platform and related applications, lead technical teams and vendors, oversee installations/upgrades/maintenance, ensure HIPAA compliance, monitor performance, handle budgets, and provide stakeholder communication and technical support.