Registered Nurse Utilization Review, Case Management, Part Time, 7P-7:30A

About the role

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.

Responsibilities

• 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.
• Covers communication with physicians.
• Identify opportunities for expedited appeals and collaborates to resolve payer issues.
• Ensures/Maintains effective communication with Revenue Cycle Departments.

Qualifications

• Degrees: Associates.
• Licenses & Certifications: MCG Care Guidelines Specialist, Registered Nurse. MCG Specialist Certification ISC/HRC required within 12 months of job entry date.
• Additional Qualifications: RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN. however, they are required to complete the BSN within 3 years of job entry date. 3 years of Nursing experience preferred.
• Additional Qualifications: Excellent written, interpersonal communication and negotiation skills. Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently. Strong analytical, data management and computer skills. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Current working knowledge of payer and managed care reimbursement preferred. Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. Knowledgeable in local, state, and federal legislation and regulations. Ability to tolerate high volume production standards.

Benefits

Baptist Health is committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a “grow our own” philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:

• Career growth and development opportunities, with clear pathways and ongoing support
• Comprehensive health and wellness resources that go beyond traditional benefits
• A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
• Tuition reimbursement to support continued learning and advancement
• And so much more

Pay

Estimated salary range for this position is $73860.80 - $98234.86 / year depending on experience.