RN Case Manager/Documentation Specialist: Expert Medical Necessity Analyst

5 days ago


Ocoee, Florida, United States Health Central Hospital Full time
Job Summary

We are seeking an experienced RN Case Manager/Documentation Specialist to join our team at Health Central Hospital. As a key member of our outpatient department, you will be responsible for ensuring the medical necessity of services and facilitating quality patient care.

About the Role

This is a challenging and rewarding opportunity for a highly skilled professional to make a significant impact on our patients' lives. You will work closely with physicians, nurses, and other healthcare professionals to develop comprehensive case management plans and ensure compliance with documentation requirements.

Key Responsibilities
  • Develop and implement comprehensive case management plans to address patient/family needs
  • Audit documentation and denied claims to ensure compliance with documentation requirements
  • Collaborate with representatives from PFS/appeals department to facilitate appeals with Administrative Law Judge
  • Conduct audits of orders written to ensure medical necessity criteria are met
  • Review claim denials and collaborate with physicians to establish medical necessity
  • Identify trends within the outpatient departments and provide staff education for performance improvement
Requirements

To be successful in this role, you will need:

  • 5 years' acute care experience or 5 years' experience in case management, hospital discharge planning, risk management, quality assurance, and/or utilization review
  • Current RN license in the state of Florida
  • Bachelor's degree in Nursing (BSN) or completion of an accredited RN education/training program
Compensation and Benefits

The estimated salary for this role is $65,000 - $85,000 per year, depending on experience. We offer a competitive benefits package, including health insurance, retirement plan, and paid time off.

About Us

Health Central Hospital is a leading provider of healthcare services in the Orlando area. We are committed to delivering high-quality patient care and improving the health outcomes of our community.



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