RN Utilization & Care Coordination Specialist

Baptist Health; Miami (FL); On-site; USD 75,000 - 100,000; Full time

Benefits offered by this job

Tuition reimbursement

Career development opportunities

Health and wellness resources

Wellness program

Job summary

Baptist Health in Florida is seeking a Registered Nurse to perform initial, concurrent, and retrospective chart reviews to support clinical financial resource utilization. The role involves coordination with the healthcare team to optimize patient outcomes while reducing length of stay and avoiding delays in reimbursement.

Requires RN licensure, familiarity with MCG guidelines, and may require an Associate degree with potential BSN pathway.

Qualifications

• Analytical skills and data management required
• Strong communication and negotiation abilities
• Excellent organizational and time-management capabilities
• RN with appropriate licensure and certifications required

Responsibilities

• Screens pre-admission and admission using established criteria
• Facilitates communication between payers and healthcare team
• Identifies delays in treatment or inappropriate utilization
• Coordinates with physicians and payers to expedite appeals and resolve issues
• Maintains communication with Revenue Cycle Departments

Skills

Analytical skills

Data management

Computer skills

Communication

Negotiation

Time management

Organization

Education

Associates degree

MCG Care Guidelines Specialist

Registered Nurse

Job description

Baptist Health in Florida is seeking a Registered Nurse to perform initial, concurrent, and retrospective chart reviews to support clinical financial resource utilization. The role involves coordination with the healthcare team to optimize patient outcomes while reducing length of stay and avoiding delays in reimbursement.

Requires RN licensure, familiarity with MCG guidelines, and may require an Associate degree with potential BSN pathway.