Clin Res Mgr Coord

LE001 Richmond Medical Center; New York (NY); On-site; USD 86,000 - 98,000; Full time

Job summary

Richmond University Medical Center in New York is seeking a Clinical Resource Manager Coordinator to support case managers with denial management, payer coordination, and data reporting. You will analyze trends, educate on documentation, and act as on-site appeals coordinator for retrospective denials.

The role includes discharge planning and cross-disciplinary collaboration to ensure quality, efficient care and optimal reimbursement.

Qualifications

• Bachelor's degree required (Masters Degree preferred).
• Current NYS RN registration with valid diploma and licensure.
• PRI and Screen certificate required.
• Minimum 5 years RN experience with supervisory utilization review/management.
• Interqual knowledge/experience preferred.
• Proficient in Microsoft Word and Excel.
• SAVVY, Invision, and RAX experience required.

Responsibilities

• Serve as a resource to Case Managers regarding denials and appeals.
• Maintain payer database and update reports as needed.
• Analyze denials and appeals for patterns and trends; educate on documentation.
• Act as on-site appeals coordinator for retrospective denials.
• Coordinate discharge planning and clinical reviews with the care team.
• Facilitate timely patient care and optimize reimbursement.
• Participate in committees and special projects.

Skills

Clinical experience

Supervisory experience

Interqual knowledge

PRI certificate

Screen certificate

SAVVY experience

Invision experience

RAX experience

Education

Bachelor's degree

Master's degree preferred

Tools

Microsoft Word

Microsoft Excel

Job description

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. Day Shift - 7.5 Hours (United States of America) The Clinical Resource Manager Coordinator will act as a resource to the Case Managers and other disciplines relative to concurrent and retrospective denials of payments. She/he will maintain payer database and updates reports as necessary (mail/log). The Coordinator will analyze denials and appeals for patterns and trends. Provides reports and researches trends in denials. Educates regarding documentation to support the patients admission (from the ED) and hospitalization stay. She/he will serve as on-site appeals coordinator and responds to retrospective denials. Discharge planning, clinical reviews and unit coverage as staffing warrants. She/he will be responsible for timely facilitation and coordination of patient care for a specific patient population or area of assignment. The job responsibilities include working effectively with the interdisciplinary team so as to plan and implement an individualized program of care that promotes high quality, efficient and cost effective care. Must assess the patient needs utilizing established standards/interqual, and other approved clinical guidelines. Ongoing communication with third party representatives and facilitate care that meets established patient care needs while optimizing care and reimbursement. Participate in committees and special projects.

Requirements

• -Bachelor's degree required (Masters Degree preferred).
• -Current registration in New York State as an RN, Diploma and Licensure required.
• -PRI and Screen certificate required.
• -Must have at least 5 years of clinical experience as a Registered Nurse and supervisory experience with utilization review/management
• -Interqual knowledge/experience preferred.
• -Knowledge of Microsoft Word and Excel required.
• -SAVVY, Invision, RAX experience required.

Days w/ eo wknd & hols; 8a-4p Salary Range: $62.339/hr - $71.223/hr (Commensurate with Experience)

Employment Non-Discrimination: Richmond University Medical Center is committed to equality of opportunity in all aspects of employment and provides full and equal employment opportunities to all employees and potential employees without regard to race, color, national origin, religion, gender identity, sex, sexual orientation, pregnancy, childbirth and related medical conditions and needs including lactation accommodations, physical or mental disability, age, immigration or citizenship status, veteran or active military status, genetic information, or any other legally protected status.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

Our Mission

We the staff of Human Resources are proud to share a long-standing tradition of excellence at Richmond University Medical Center. We uphold the mission by providing premier quality patient care through a full spectrum of emergent, acute, primary, behavioral health and educational services, and value the pride and integrity that motivate us to always be more, and always be better. We are committed to our mission and values because WE CARE! We are Welcoming, Energized, Compassionate, Advocates, Respectful and Excellent in our interaction with our patients, families, visitors and co-workers. WE CARE W We are welcoming and gracious toward each other, and toward all who come to receive our services. E Personnel are energized for quality, creativity, commitment and teamwork. C Compassion is the way we share deep concern and care toward each person. A Advocacy is our activity that promotes the rights and responsibilities of patients, families, and staff, in the hospital setting and in the community. R We show respect by recognizing the basic dignity of every person in all our interactions and in the formulation of policies and procedures. E Excellence is our way of demonstrating that we can always be more and always be better.