RN Utilization Review Full-time
North Mississippi Health Services

Coordinator-RN Utilization

North Mississippi Health Services Amory, MS 38821, US
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Coordinates

 Essential Functions

  • 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 Requirements:
  • 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

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