Registered Nurse Utilization Review, Case Management, FT, 8:30A-5P
About the position 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 to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments. Estimated salary range for this position is $73860.80 - $98234.86 / year depending on experience.
Responsibilities
- Conduct initial, concurrent, retrospective chart review for clinical financial resource utilization.
- Coordinate with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days.
- Provide intervention and coordination to decrease avoidable delays and denial of reimbursement for a designated patient caseload.
- Screen pre-admission and admission process using established criteria for all points of entry.
- Facilitate communication between payers, review agencies, and the healthcare team.
- Identify delays in treatment or inappropriate utilization and serve as a resource.
- Coordinate communication with physicians.
- Identify opportunities for expedited appeals and collaborate to resolve payer issues.
- Ensure and maintain effective communication with Revenue Cycle Departments.
Requirements
- Associate's Degree in Nursing.
- MCG Care Guidelines Specialist certification.
- Registered Nurse license.
- 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.
- MCG Specialist Certification ISC/HRC required within 12 months of job entry date.
- 3 years of Nursing experience.
- 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.
- 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.
Nice-to-haves
- Current working knowledge of payer and managed care reimbursement preferred.
Benefits
- 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