RN Coordinator-Utilization

LE101 North Mississippi Medical Center, Inc; Mississippi; In loco; USD 65.000 - 81.000; Tempo pieno

Descrizione del lavoro

North Mississippi Health Services is seeking an RN Utilization Coordinator to manage utilization and case management activities. You will collaborate with physician services, perform clinical reviews, educate care teams, and ensure regulatory compliance.

The role emphasizes efficient patient status determinations for inpatient, outpatient, and observation services. Requirements include an Associate’s Degree in Nursing (RN licensed) with ACM certification preferred.

Competenze

• Associate’s Degree in Nursing (required).
• Bachelor’s Degree in Nursing (not required).
• ACM certification and RN licensure per state requirements.
• Excellent written and verbal communication skills are essential.

Mansioni

• Consults with physician services to coordinate care.
• Performs initial and concurrent clinical reviews for payer needs.
• Educates care team on level of care criteria and payer requirements.
• Coordinates final status with admitting and attending physicians.
• Handles precertification/notification with payers and facilitates denials/appeals.

Conoscenze

Excellent organizational skills

Excellent written & verbal comms

Payer knowledge & regulations

Interpersonal skills

Patient population care

Independent work

Problem solving

PI involvement

Regulatory compliance

Positive attitude

Formazione

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing

Descrizione del lavoro

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.

Department / Shift

Department: 10007915

Work Shift: Variable shift, Monday thru Friday primarily with some weekend work

Job Description

The RN Utilization Coordinator at North Mississippi Health Services is responsible for coordinating and performing various tasks related to utilization management and case management services. They work with physician services, perform clinical reviews, educate care team members, and ensure compliance with regulatory guidelines.

Job 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.

Knowledge, Skills and Abilities

• Excellent organizational and communication (written and verbal) skills; required
• Knowledge of various payer sources, federal/state laws/regulations, and cost containment; required
• Excellent interpersonal skills; required
• Demonstrates ability to care for a patient population from pediatric to geriatric; required
• Works independently as well as in a team setting
• Resolves problems/issues related to patient outcomes
• Assists with departmental Performance Improvement (PI)
• Assures compliance with regulatory guidelines and applicable laws/statues
• Must have excellent written and verbal communication skills
• Must reflect a positive, caring attitude toward clients, patients, staff and the public we serve

Physical Demands

Standing. Constantly Walking. Constantly Sitting. Occasionally Lifting/Carrying. Frequently 50 lbs Pushing/Pulling. Frequently Climbing. Occasionally Balancing. Occasionally Stooping/Kneeling/Bending. Occasionally Reaching/Over Head Work. Occasionally Grasping. Frequently Speaking. Constantly Hearing. Constantly Repetitive Motions. Constantly Eye/Hand/Foot Coordination.

Salary Range: $65,166.40-$81,463.20

Education

Associate’s Degree | Nursing | Required

Bachelor’s Degree | Nursing | Not Required

Certifications

Accredited Case Manager (ACM) - ACM, Registered Nurse (MS) - MS Board of Nursing

Company Overview

North Mississippi Health Services is a large rural health care system with state-of-the-art facilities in Mississippi and Alabama. We have career opportunities ranging from inpatient hospital care to 70+ rural health and specialty clinics, a variety of outpatient, women's and behavioral health services and many additional support services. Our team of over 7,000 works together every day toward our shared mission - to continuously improve the health of the people of our region.