Registered Nurse Utilization Review, Case Management, FT, 8:30A-5P
3 weeks ago
Baptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties.
Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. Baptist Health is supported by philanthropy and committed to its faith-based charitable mission of medical excellence.
Our mission, vision, and values make us who we are at Baptist Health and are at the center of everything we do.
Our success comes from a culture of quality and dedication that is instilled into every member of the Baptist Health family.
This year, and for 24 years, we've been named one of Fortune's 100 Best Companies to Work For, based on employee feedback.
We've also been recognized as one of America's Most Innovative Companies and People Magazine included us in 50 Companies That Care.
Based on the U.S.News & World Report Best Hospital Rankings, Baptist Health is the most awarded healthcare system in South Florida, with its hospitals and institutes earning 45 high-performing honors.
But really, the reason we're excited to come to work is the people.
Working together, we form personal connections with our colleagues that are stronger than most of us have experienced at other jobs.
We're committed to delivering quality care in the most compassionate way possible because we feel a personal stake in the outcomes.
When it comes to caring for people, we're all in.Description
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 resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments. Estimated salary range for this position is $ $ / year depending on experience.
Qualifications
Degrees:
Associates Licenses & Certifications: Registered Nurse NBCC Certification in Continuity of Care, Advanced CCMC Case Manager CDMS Certified Disability Management Specialist ACMA ACM Certification ABMCM Certified Managed Care Nurse McKesson Certified Professional in Utilization Management AAMCN Utilization Review Professionals RNCB Certified Rehabilitation Registered Nurse ANCC Nursing Case Management NACCM
Care Manager Certified Additional Qualifications:
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, however, they are required to complete the BSN within 5 years of hire.
A Utilization Review or Case Management Certification required within 12 months of hire. 3 years of hospital clinical experience preferred. 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.Minimum Required Experience:
3
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