Coordinator-RN Utilization (NE)

North Mississippi Health Services; Tupelo (MS); On-site; USD 62,000 - 86,000; Full time

Job summary

North Mississippi Health Services seeks an experienced Registered Nurse for case management and coordination across inpatient and outpatient settings. The role emphasizes collaborating with physicians, payers, and the care team to determine appropriate levels of care and ensure compliant documentation.

The ideal candidate will have an active Mississippi RN license, a minimum of five years of healthcare experience, and strong organizational and communication skills.

Qualifications

• Requires Associates Degree in Nursing; Bachelor's preferred.
• Licensed as a Registered Nurse by the Mississippi Board of Nursing.
• Minimum of 5 years clinical/healthcare experience required.
• Excellent organizational and written/verbal communication skills required.
• Certified Accredited Case Manager (ACM) desirable.

Responsibilities

• Coordinates with physician services and care teams to determine patient status.
• Reviews clinical data and payer guidelines to support appropriate level of care.
• Notifies and coordinates with inpatient/outpatient services and payers.
• Maintains documentation and shares medical necessity information with payers.
• Adheres to NMHS/NMMC policies and applicable laws and regulations.

Skills

Organizational skills

Written & verbal communication

Interpersonal skills

Care coordination

Education

Associates Degree in Nursing

Bachelor’s Degree preferred

Registered Nurse (RN) license—Mississippi

ACM certification desirable

Job description

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.

List major areas of responsibility and briefly what the person does in each area.

Essential Functions

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