RN Utilization Review Specialist

Baptist Health; Miami (FL); On-site; USD 53,000 - 76,000; Full time

Job summary

Baptist Health, the region's largest not-for-profit health system, is seeking a Registered Nurse to conduct chart reviews for clinical, financial and utilization decisions. You will coordinate with care teams to improve patient outcomes, shorten stays, and resolve payer issues.

Minimum Associates degree and RN license required; 3 years hospital experience preferred. The role emphasizes collaboration with Revenue Cycle and payer review processes, with a pay rate around $47 per hour depending on

Qualifications

• Associates degree required.
• Registered Nurse license required.
• 3 years hospital clinical experience preferred.
• Excellent written, interpersonal communication and negotiation skills.
• Strong critical thinking and ability to perform clinical chart review.
• Strong analytical, data management and computer skills.
• Strong organizational and time management skills.
• Knowledgeable in payer and managed care reimbursement.
• Ability to work independently with sound judgment.
• Knowledge of local, state, and federal regulations.

Responsibilities

• Perform initial, concurrent, and retrospective chart review for clinical, financial and utilization.
• Coordinate with healthcare team for optimal patient outcomes and shorter length of stay.
• Communicate with payers and review agencies; identify delays in treatment or utilization.
• Identify opportunities for expedited appeals and assist in resolving payer issues.

Skills

Critical thinking

Interpersonal communication

Negotiation

Analytical data

Time management

Organizational skills

Independent work

Payer knowledge

Education

Associate's degree in Nursing

Registered Nurse license

Job description

Baptist Health, the region's largest not-for-profit health system, is seeking a Registered Nurse to conduct chart reviews for clinical, financial and utilization decisions. You will coordinate with care teams to improve patient outcomes, shorten stays, and resolve payer issues.

Minimum Associates degree and RN license required; 3 years hospital experience preferred. The role emphasizes collaboration with Revenue Cycle and payer review processes, with a pay rate around $47 per hour depending on