Resource Utilization Nurse

Global Medical Response•Birmingham, AL

1d•Hybrid

About The Position

Insurance Verification and Resource Utilization Nurse Immediate Supervisor: Clinical Coordinator Manager Director Department: Medical Operations. Utilizing a collaborative process, the clinical coordinator assesses, plans and facilitates the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost effective outcomes. Identifies appropriate providers and facilities throughout the continuum of services (as needed) while ensuring that available resources are being used in a timely and cost effective manner. Maintains fiscal responsibility on AirMed’s behalf and serves as an advocate for the patient in all aspects of the transport.

Requirements

Must hold a valid nursing license from the County and/or State(s) of primary practice and/or clinical oversight as required for all US based operations.
Minimum of three years clinical experience in an inpatient setting.
Minimum of one year experience in insurance authorization, billing, and/or coding.
Excellent and effective interpersonal, verbal and written communication skills.
Ability to work independently and make decisions.
Must obtain a certification in case management within two years or other approved advanced certification.

Nice To Haves

Advanced practice experience and education preferred.
Case Management experience is preferred.

Responsibilities

Obtains prior authorization and insurance verification for medical air/ground transport
Maintains fluency in data entry using ICD-10 and CPT Codes
Provides excellent customer service, written communication and computer skills
Multitasks and communicates efficiently in fast paced environment
Maintains a high level of organizational skills with exceptional attention to detail
Identifies appropriate providers and facilities throughout the continuum of services (as needed) while ensuring that available resources are being used in a timely and cost effective manner.
Maintains fiscal responsibility on AirMed’s behalf and serves as an advocate for the patient in all aspects of the transport.