RN: Precertification & Utilization Review Lead

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

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.