RN Precert & Medical Review Navigator

Baptist Memorial Health Care Corporation; Memphis (TN); On-site; USD 62,000 - 82,000; Full time

Job summary

Baptist Memorial Health Care Corporation in Memphis, Tennessee seeks a Precertification Coordinator to manage precertification/authorization for inpatient and outpatient services, coordinating across departments to ensure timely billing and appropriate care.

The role requires strong communication, organizational skills, and the ability to work with multiple payers; RN CCM ACM licensure preferred; some overtime and on-call may be required.

Qualifications

• 3 years of clinical experience; utilization/case management preferred.
• RN license with CCM and ACM certifications preferred.
• Strong communication and organizational skills; advanced computer literacy.

Responsibilities

• Assess and evaluate clinical and financial information to optimize care and reimbursement.
• Precertify patient care services in a timely, efficient manner to optimize reimbursement.
• Communicate recommendations and information to internal and external customers to facilitate service delivery and satisfaction.
• Review orders for accuracy and medical necessity to ensure appropriate reimbursement.
• Address issues identified with retrospective reviews for all payers.
• Ensure outpatient procedures are precertified when applicable.
• Contribute to QI/PI process improvements.
• Pursue personal growth through inservices and continuing education.

Skills

Advanced communication

Conflict management

Organizational skills

Planning skills

Computer literacy

Education

RN licensure

CCM certification

ACM certification

Job description

Baptist Memorial Health Care Corporation in Memphis, Tennessee seeks a Precertification Coordinator to manage precertification/authorization for inpatient and outpatient services, coordinating across departments to ensure timely billing and appropriate care.

The role requires strong communication, organizational skills, and the ability to work with multiple payers; RN CCM ACM licensure preferred; some overtime and on-call may be required.