RN - Precertification & Utilization Review Specialist

Baptist Memorial Health Care; Memphis (TN); On-site; USD 42,000 - 64,000; Full time

Job summary

Baptist Memorial Health Care in Memphis seeks a precertification coordinator to lead patient preauthorization across the continuum of care, ensuring timely, accurate certification and efficient billing of claims.

You will coordinate with departments, review orders for medical necessity, communicate recommendations to internal and external customers, and participate in QI/PI initiatives while pursuing professional development.

Qualifications

• Minimum 3 years of clinical experience.
• Prefer experience in utilization/case management.
• Advanced communication, conflict management, organizational and planning skills; advanced computer literacy.

Responsibilities

• Assesses and evaluates clinical and financial information to optimize resource use and reimbursement.
• Precertifies patient care services timely to optimize reimbursement for patient and providers.
• Communicates recommendations, clinical information, and fiscal information to internal and external customers.
• 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.

Skills

Communication skills

Conflict management

Organizational skills

Planning skills

Advanced computer literacy

Job description

Baptist Memorial Health Care in Memphis seeks a precertification coordinator to lead patient preauthorization across the continuum of care, ensuring timely, accurate certification and efficient billing of claims.

You will coordinate with departments, review orders for medical necessity, communicate recommendations to internal and external customers, and participate in QI/PI initiatives while pursuing professional development.