McLeod Health - Florence, SC
posted 9 days ago
About the position
The position involves maintaining a professional image and exhibiting excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values. The role includes coordinating and facilitating patient care progression throughout the continuum of care, ensuring that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective. Additionally, the position requires communication with payers regarding medical necessity for status and level of care ordered to obtain authorization and reimbursement for care rendered. Continuous monitoring of length of stay and ancillary resource use is essential, along with communication of information to the Case Management team to aid in appropriate level of care determination and reimbursement by third-party payors. The role also involves documenting all payer communication for the care team and billing, covering various populations across the organization in relation to Utilization Review, and performing other duties as requested by the Case Manager Supervisor and/or Director.
Responsibilities
- Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers.
- Coordinates/facilitates patient care progression throughout the continuum of care.
- Assures the plan of care and services provided are patient focused, high quality, efficient and cost effective.
- Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered.
- Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas.
- Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by third party payors.
- Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process form.
- Insures that all payer communication is documented for the care team as well as billing.
- Ability to cover various populations across the organization in relation to Utilization Review.
- Performs all other duties as requested by Case Manager Supervisor and/or Director.
Requirements
- 1-2 years of recent acute care hospital experience required
- Data entry/computer experience required
- Registered Nurse from an NLN accredited school of nursing required
- Licensed LPN or RN to practice within the applicable region of employment and coverage area of responsibility is required.
