Registered Nurse Utilization Review, Care Coordination, Bethesda East, FT, 08A-4:30P Local REMOTE

Baptist Health; Boynton Beach (FL); Remote; USD 72,000 - 95,000; Full time

Job summary

An established industry player is seeking a dedicated professional to conduct comprehensive chart reviews aimed at optimizing patient outcomes. This role involves working closely with healthcare teams to manage patient caseloads effectively, reduce delays, and prevent reimbursement denials. The ideal candidate will leverage strong communication skills to facilitate collaboration between payers and healthcare providers, ensuring a seamless process that enhances patient care. Join a forward-thinking organization where your contributions will directly impact the quality of healthcare services provided.

Qualifications

• Experience in conducting chart reviews and managing patient caseloads.
• Strong communication skills for coordinating with healthcare teams.

Responsibilities

• Conduct initial, concurrent, and retrospective chart reviews.
• Facilitate communication between payers and healthcare teams.
• Identify delays in treatment and coordinate solutions.

Skills

Chart Reviews

Patient Coordination

Communication Skills

Healthcare Team Collaboration

Financial Resource Utilization

Job description

Description:

The purpose of this position is to conduct initial, concurrent, and retrospective chart reviews for clinical financial resource utilization. The role involves coordinating with healthcare teams to optimize patient outcomes, reduce length of stay (LOS), and prevent delays and denied days. The incumbent is responsible for managing a designated patient caseload, providing intervention and coordination to decrease avoidable delays and reimbursement denials. Specific functions include:

1. Screening pre-admission and admission processes using established criteria for all entry points.
2. Facilitating communication between payers, review agencies, and healthcare teams.
3. Identifying delays in treatment or inappropriate utilization and serving as a resource.
4. Coordinating communication with physicians.
5. Identifying opportunities for expedited appeals and collaborating to resolve payer issues.
6. Ensuring effective communication with Revenue Cycle Departments.

Estimated salary range for this position is $72,779.20 - $94,612.96 per year, depending on experience.