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Registered Nurse Utilization Review, Case Management, Per Diem, 8A-4:30P
4 months 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.
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 and resource utilization.
Coordinates with healthcare Team for optimal efficient patient outcomes, while decreasing length of stay and avoid delays and denied days.
They are accountable for a designated patient caseload and provides intervention and 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 and 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 and ensures, maintains effective communication with Revenue Cycle Departments.
Estimated pay range for this position is $45.00 / hour depending on experienceQualifications:
Degrees:
Associates
Licenses & Certifications:
CCMC Case Manager
CDMS Certified Disability Management Specialist
Registered Nurse
ABMCM Certified Managed Care Nurse
McKesson Certified Professional in Utilization Management
AAMCN Utilization Review Professionals
RNCB Certified Rehabilitation Registered Nurse
ANCC Nursing Case Management
ACMA ACM Certification
NBCC Certification in Continuity of Care, Advanced
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, required to complete the BSN within 5 years of hire.
Minimum Required Experience:
3
EOE