[Hiring] Utilization Review Registered Nurse, Case Management @Baptist Health South Florida

Role Description

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 avoiding delays and denied days. They are accountable for a designated patient caseload and provide intervention and coordination to decrease avoidable delays and denial of reimbursement.

• Screens pre-admission and admission processes using established criteria for all points of entry.
• Facilitates communication between payers, review agencies, and the healthcare team.
• Identifies delays in treatment or inappropriate utilization and serves as a resource.
• Coordinates communication with physicians.
• Identifies opportunities for expedited appeals and collaborates to resolve payer issues.
• Ensures and maintains effective communication with Revenue Cycle Departments.

Estimated salary range for this position is $73,860.80 - $96,019.04 / year depending on experience.

Qualifications

• Degrees: Associates.
• Licenses & Certifications:
  • MCG Care Guidelines Specialist.
  • Registered Nurse.
• Additional Qualifications:
  • 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 preferred.
  • 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 healthcare team and patients/families.
  • Knowledgeable in local, state, and federal legislation and regulations.
  • Ability to tolerate high volume production standards.

Requirements

• Minimum Required Experience: 3 Years of Nursing experience with 1 year of previous Utilization Review experience required.

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.
• And so much more.