Coordinator-RN Utilization (NE)

Job ID:

000GER Tupelo Professionals - UTILIZATION

MANAGEMENT PRN

- Variable Posting Description We believe a career is more than just a career — it's a calling. Our teammates' "True North" is what calls them to health care; it's their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love. Job Description Essential Functions List major areas of responsibility and briefly what the person does in each area.

Coordinates:

Consults with physician services Utilizes clinical diagnostics, physician documentation and non-physician clinical guidelines to facilitate status determination of inpatient, outpatient or outpatient observation. Coordinates final status with admitting and attending physicians Performs initial and concurrent clinical reviews as indicated by payer and patient clinical needs Inpatient and/or outpatient notification and precertification of services to payers Facilitates peer to peer, written reconsiderations or appeals throughout all denial cycle as appropriate Facilitates appropriate observation utilization Consults with patient financial services

Educations:

Provides education and literature to physician services regarding IPPS and OPPS Educates physicians and other care team member on level of care criteria and other third party payer requirements

Reporting/Recordkeeping:

Updates patient's medical records as required Shares medical necessity documentation with payers to facilitate reimbursement

Regulation :

Adheres to

NMHS/NMMC

Policies/Procedures/Guidelines Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues

Know How Job Knowledge:

Specify required education, licensure/certification, prior experience, skill behavior, equipment operation, type and duration of on-the-job training, patient population to be served, etc. Associates Degree in Nursing, required; Bachelor's Degree preferred Licensed as a Registered Nurse by the Mississippi Board of Nursing; required Minimum of 5 years clinical and/or healthcare experience; required Excellent organizational and communication (written and verbal) skills; required Knowledge of various payer sources, federal/state laws/regulations, and cost containment; required Certified as an Accredited Case Manager (ACM); desirable Excellent interpersonal skills; required Demonstrates ability to care for a patient population from pediatric to geriatric; required Requirements The following are requirements in addition to any stated in the above description. Licenses You must have the following licenses to apply: Registered Nurse Education You must have the following education to apply: Associates of Nursing You must have a Associates or higher