RN Healthcare Utilization Specialist
1 week ago
Position Summary:
We are seeking a highly skilled RN-Utilization Review professional to join our team at Baptist Memorial Health Care. In this role, you will be responsible for evaluating medical necessity and appropriateness of healthcare services and treatments, prioritizing observation case review, assisting with level of care in collaboration with attending providers, and entering working diagnosis-related groups (DRGs) in the electronic medical record.
Key Responsibilities:
- Evaluates medical necessity and appropriateness of healthcare services and treatments
- Prioritizes observation case review
- Assists with level of care in collaboration with attending providers
- Enters working diagnosis-related groups (DRGs) in the electronic medical record
- Submits clinical information to payer per payer requirements
- Completes continued stay reviews every 3 days or more often if required
- Communicates with care coordinators for authorized days, level of care, medical necessity or other areas when indicated
- Communicates with physician advisors related to status concerns or denials
- Updates auth/cert screen in the electronic medical record
- Works assigned queues in the electronic medical record
- Communicates with authorization coordinator
- Communicates in-house high dollar case information
- Completes assigned goals
Qualifications:
- RN with 3 years of clinical experience
- Critical thinking skills, clinical knowledge, attention to detail communication, organization, interpersonal, time management and computer skills
- Problem solving; and knowledge of governmental regulations
Compensation:
The estimated salary for this position is $80,000 - $100,000 per year, depending on experience and qualifications. Benefits include paid vacation/time off, continuing education opportunities, generous retirement plan, health insurance, sick leave, service awards, free parking, short-term disability, life insurance, health care and dependent care spending accounts, education assistance/continuing education, and employee referral program.
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