Clin Res Mgr Coord
About The Position
The Clinical Resource Manager Coordinator will act as a resource to the Case Managers and other disciplines relative to concurrent and retrospective denials of payments. She/he will maintain payer database and updates reports as necessary (mail/log). The Coordinator will analyze denials and appeals for patterns and trends. Provides reports and researches trends in denials. Educates regarding documentation to support the patients admission (from the ED) and hospitalization stay. She/he will serve as on-site appeals coordinator and responds to retrospective denials. Discharge planning, clinical reviews and unit coverage as staffing warrants. She/he will be responsible for timely facilitation and coordination of patient care for a specific patient population or area of assignment. The job responsibilities include working effectively with the interdisciplinary team so as to plan and implement an individualized program of care that promotes high quality, efficient and cost effective care. Must assess the patient needs utilizing established standards/interqual, and other approved clinical guidelines. Ongoing communication with third party representatives and facilitate care that meets established patient care needs while optimizing care and reimbursement. Participate in committees and special projects.
Requirements
- Bachelor's degree required.
- Current registration in New York State as an RN, Diploma and Licensure required.
- PRI and Screen certificate required.
- At least 5 years of clinical experience as a Registered Nurse.
- Supervisory experience with utilization review/management.
- Knowledge of Microsoft Word and Excel required.
- SAVVY, Invision, RAX experience required.
Nice To Haves
- Masters Degree preferred.
- Interqual knowledge/experience preferred.
Responsibilities
- Act as a resource to Case Managers and other disciplines relative to concurrent and retrospective denials of payments.
- Maintain payer database and updates reports as necessary.
- Analyze denials and appeals for patterns and trends.
- Provide reports and research trends in denials.
- Educate regarding documentation to support patient admission and hospitalization.
- Serve as on-site appeals coordinator and respond to retrospective denials.
- Perform discharge planning, clinical reviews, and unit coverage as staffing warrants.
- Facilitate and coordinate patient care for a specific patient population or area of assignment.
- Work effectively with the interdisciplinary team to plan and implement an individualized program of care.
- Assess patient needs utilizing established standards/Interqual, and other approved clinical guidelines.
- Maintain ongoing communication with third party representatives.
- Facilitate care that meets established patient care needs while optimizing care and reimbursement.
- Participate in committees and special projects.
Benefits
- Commensurate with Experience
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
