RN-Order/Medical Review

Baptist; Collierville (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

Baptist is seeking a Coordinator for the Centralized Patient Access Center to oversee precertification/authorization across care settings. You will lead preauthorization efforts for inpatient and outpatient services, coordinate interdepartmental actions, and help ensure timely billing and optimal resource use.

The role involves some overtime and callbacks, reporting to the CPAC Director, and ongoing professional development to meet performance goals.

Qualifications

• Minimum 3 years of clinical experience; utilization/case management preferred.
• RN licensure with CCM/ACM certifications is desirable.
• Advanced communication, conflict management, organizational and planning skills; computer literacy.

Responsibilities

• Assess and evaluate clinical and financial information to optimize services and reimbursement.
• Precertify patient care services promptly to optimize reimbursement for patients and providers.
• Communicate recommendations and information to internal and external customers for optimal service delivery.
• Review orders for accuracy and medical necessity to support proper care and reimbursement.
• Address issues identified with retrospective payer reviews.
• Ensure outpatient procedures are precertified when applicable.
• Contribute to quality improvement and PI processes.
• Pursue growth through ongoing education and training.
• Complete assigned goals.

Skills

Advanced communication

Conflict management

Organizational skills

Planning skills

Computer literacy

Education

RN

CCM

ACM

Job description

• Department Centralized Patient Access Center

Job Description

Job Summary Coordinates precertification/authorization services for patients across the continuum of care, promoting quality care, and effective utilization of resources. Provides leadership when dealing with patient preauthorization functions, including inpatient and outpatient services. Coordinates efforts between departments to ensure accurate precertification, resulting in timely billing of claims. Some overtime and call back may be required. Reports to the Director of CPAC. Performs other duties as assigned.

Job Responsibilities

• Assesses and evaluates clinical and financial information available and recommends the most appropriate delivery of services, including level of care in order to optimize resource consumption and reimbursement.
• Precertifies patient care services that require precertification, in a timely, efficient manner, in order to optimize reimbursement for the patient as well as health care providers.
• Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
• Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement.
• Addresses issues identified with retrospective reviews for all payers.
• All outpatient procedures will be timely precerted when applicable.
• Works to improve the QI/PI process.
• Assumes responsibility for personal growth and development by attendance and / or participation in inservices and continuing education programs.
• Completes assigned goals.

Experience Description Minimum Required Preferred/Desired 3 years of clinical experience. Prefer experience in utilization/case management. Education Description Minimum Required Preferred/Desired Training Description Minimum Required Preferred/Desired Special Skills Description Minimum Required Preferred/Desired Advanced communication, conflict management, organizational and planning skills; advanced computer literacy skills. Prefer certification in CPHQ, CCM, ACM Licensure Description Minimum Required Preferred/Desired RN CCM;ACM