RN-Pre Admission

Baptist • New Albany, MS

2d

About The Position

Job Summary Coordinates preadmission and outpatient registration services for patients across the continuum of care, promoting quality care, and effective utilization of resources. Provides leadership when dealing with patient preadmission functions, including inpatient and outpatient services. Reviews, researches and coordinates efforts between departments to ensure accurate, timely billing of claims hitting for Caremedic LCD edits. Evaluates, assesses, plans and facilitates a plan of care. Some overtime and call back may be required. Reports to the Director of Case Management. Performs other duties as assigned. Responsibilities Assesses and evaluates clinical and financial information available and recommends the most appropriate delivery of services, including level of care in order to optimize resource consumption and reimbursement. Precertifies patient care services that require precertification, in a timely, efficient manner, in order to optimize reimbursement for the patient as well as health care providers. Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction. Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement. Addresses issues identified with retrospective reviews for all payers. Reviews Caremedic claims in LCD status for medical necessity. Works to improve the QI/PI process. Assumes responsibility for personal growth and development by attendance and / or participation in in-services and continuing education programs. Completes assigned goals. Specifications Experience Minimum Required 3 years of clinical experience. Preferred/Desired Prefer experience in utilization/case management. Education Minimum Required Preferred/Desired Training Minimum Required Preferred/Desired Special Skills Minimum Required Advanced communication, conflict management, organizational and planning skills; advanced computer literacy skills. Preferred/Desired Certification in CPHQ, CCM, ACM Licensure Minimum Required RN Preferred/Desired CCM;ACM

Requirements

• 3 years of clinical experience.
• Advanced communication, conflict management, organizational and planning skills
• Advanced computer literacy skills.
• RN

Nice To Haves

• Experience in utilization/case management.
• Certification in CPHQ, CCM, ACM
• CCM;ACM

Responsibilities

• Assesses and evaluates clinical and financial information available and recommends the most appropriate delivery of services, including level of care in order to optimize resource consumption and reimbursement.
• Precertifies patient care services that require precertification, in a timely, efficient manner, in order to optimize reimbursement for the patient as well as health care providers.
• Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
• Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement.
• Addresses issues identified with retrospective reviews for all payers.
• Reviews Caremedic claims in LCD status for medical necessity.
• Works to improve the QI/PI process.
• Assumes responsibility for personal growth and development by attendance and / or participation in in-services and continuing education programs.
• Completes assigned goals.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees