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Pool Utilization Review Registered Nurse, Shift Varies - Homestead, Florida - Utilization Review

Company: Baptist Health South Florida
Location: Homestead
Posted on: January 9, 2022

Job Description:

Baptist Health South Florida is once again one of the 2021 Fortune 100 Best Companies to Work For! This is the 21st time Baptist Health has been recognized on the list. We have also been recognized for being among the best healthcare providers in the nation by U.S. News & World Reports in its 2020-2021 Best Hospitals and have been honored as one of PEOPLE's 2020 50 Companies that Care by PEOPLE magazine and Great Place to Work.Baptist Health South Florida is the region's largest not-for-profit healthcare organization with more than 23,000 employees working across 11 hospital campuses and more than 100 outpatient facilities throughout Miami-Dade, Monroe, Broward, and Palm Beach counties. In 2016 we welcomed the newest weapon in the fight against cancer, the world-class Miami Cancer Institute and proton therapy center.Everything we do at Baptist Health, we do to the best of our ability. That includes supporting our team with extensive training programs, millions of dollars in tuition assistance, comprehensive benefits and more. Working within our award-winning culture means getting the respect and support you need to do your best work ever. Find out why this is the best place to be your best!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.Qualifications:Degrees:

Licenses & Certifications:
ACMA ACM Certification
Registered Nurse
RNCB Certified Rehabilitation Registered Nurse
AAMCN Utilization Review Professionals
McKesson Certified Professional in Utilization Management
ABMCM Certified Managed Care Nurse
NACCM Care Manager Certified
CDMS Certified Disability Management Specialist
CCMC Case Manager
NBCC Certification in Continuity of Care, Advanced
ANCC Nursing Case Management

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. 3 years of hospital clinical experience preferred. A Utilization Review or Case Management Certification required within 12 months of hire. 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, and ability to tolerate high volume production standards.

Minimum Required Experience:

Keywords: Baptist Health South Florida, Homestead , Pool Utilization Review Registered Nurse, Shift Varies - Homestead, Florida - Utilization Review, Healthcare , Homestead, Florida

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