RN - Utilization Review & Payer Liaison

Baptist Health; Town of Florida (NY); On-site; USD 75,000 - 100,000; Full time

Job summary

Baptist Health is seeking a Registered Nurse with associates-level education to conduct chart reviews for clinical financial resource utilization. The role coordinates with the care team to improve patient outcomes while decreasing length of stay and minimizing delays and denied days.

Strong communication with payers is essential for efficient reimbursement. Minimum experience: 3 years in nursing; certification in MCG guidelines preferred.

Qualifications

• Associates degree in Nursing is required.
• RN licensure in good standing is required.
• MCG Care Guidelines Specialist certification is preferred.
• 3 years of Nursing experience preferred and knowledge of payer reimbursement.

Responsibilities

• Perform initial, concurrent, and retrospective chart reviews for clinical financial resource utilization.
• Coordinate with the healthcare team to optimize patient outcomes and reduce length of stay.
• Identify delays in treatment and opportunities for expedited appeals; liaise with payers and review agencies.
• Maintain effective communication with Revenue Cycle Departments and care providers.

Skills

Analytical thinking

Chart review

Interpersonal skills

Negotiation skills

Education

Associates in Nursing

RN License (state)

MCG Care Guidelines Specialist

Job description

Baptist Health is seeking a Registered Nurse with associates-level education to conduct chart reviews for clinical financial resource utilization. The role coordinates with the care team to improve patient outcomes while decreasing length of stay and minimizing delays and denied days.

Strong communication with payers is essential for efficient reimbursement. Minimum experience: 3 years in nursing; certification in MCG guidelines preferred.