Registered Nurse Utilization Review, Case Management, Part Time, 8:30A-5P

Baptist Health South Florida • Miami, FL

370d • $72,779 - $96,796

About The Position

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments.

Requirements

• Associates degree required.
• MCG Care Guidelines Specialist certification required within 12 months of job entry date.
• Registered Nurse license required.
• 3 years of Nursing experience preferred.
• Excellent written, interpersonal communication, and negotiation skills.
• Strong critical thinking skills and ability to perform clinical/chart review efficiently.
• Strong analytical, data management, and computer skills.
• Strong organizational and time management skills.
• Current working knowledge of payer and managed care reimbursement preferred.
• Ability to work independently and exercise sound judgment in interactions with healthcare team and patients/families.
• Knowledgeable in local, state, and federal legislation and regulations.
• Ability to tolerate high volume production standards.

Nice To Haves

• RNs hired prior to 2-2012 with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN, but must complete the BSN within 5 years of job entry date.

Responsibilities

• Conduct initial, concurrent, retrospective chart review for clinical financial resource utilization.
• Coordinate with healthcare team for optimal patient outcomes.
• Decrease length of stay (LOS) and avoid delays and denied days.
• Accountable for a designated patient caseload.
• Provide intervention and coordination to decrease avoidable delays and denial of reimbursement.
• Screen pre-admission and admission processes using established criteria.
• Facilitate communication between payers, review agencies, and healthcare team.
• Identify delays in treatment or inappropriate utilization and serve as a resource.
• Coordinate communication with physicians.
• Identify opportunities for expedited appeals and collaborate to resolve payer issues.
• Maintain effective communication with Revenue Cycle Departments.

Benefits

• Estimated salary range for this position is $72779.20 - $96796.34 / year depending on experience.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees