Pool Utilization Review RN, Case Management, Per Diem, 8A-4:30P

Company: Baptist Health South Florida
Location: Boca Raton
Posted on: January 15, 2022

Job Description:

Baptist Health has a commitment to strengthening thecompassionate care we provide. With the addition of Boca Raton RegionalHospital, Baptist Health is able to provide the Palm Beach community expandedaccess to healthcare services.Boca Raton Regional Hospital is an advancedtertiary medical center with 400 beds and is a recognized leader inCardiovascular Care, Oncology, Women's Health, Orthopedics, Emergency Medicineand the Neurosciences, all of which offer state-of-the-art diagnostic andimaging capabilities. The Hospital is now a part of Baptist Health SouthFlorida is the region's largest not-for-profit healthcare organization withmore than 23,000 employees working across 11 hospital campuses and more than100 outpatient facilities throughout Miami-Dade, Monroe, Broward, and PalmBeach counties. In 2016 we welcomed the newest weapon in the fight againstcancer, the world-class Miami Cancer Institute and proton therapy center.Baptist Health South Florida is once again oneof the 2019 Fortune 100 Best Companies to Work For! This is the 19th timeBaptist Health has been recognized on the list. We have also been recognizedfor being among the best healthcare providers in the nation by U.S. News &World Reports in its 2019-2020 Best Hospitals report and have been honored asone of PEOPLE's 2019 50 Companies That Care by PEOPLE magazine and Great Placeto Work.Everything we do at Baptist Health, we do to thebest of our ability. That includes supporting our team with extensive trainingprograms, millions of dollars in tuition assistance, comprehensive benefits andmore. Working within our award-winning culture means getting the respect andsupport you need to do your best work ever. Find out why this is the best placeto be your best! Description The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments.Qualifications Degrees: Associates Licenses Certifications: RNCB Certified Rehabilitation Registered Nurse AAMCN Utilization Review Professionals McKesson Certified Professional in Utilization Management ABMCM Certified Managed Care Nurse NACCM Care Manager Certified CDMS Certified Disability Management Specialist CCMC Case Manager ACMA ACM Certification NBCC Certification in Continuity of Care, Advanced Registered Nurse ANCC Nursing Case Management Additional Qualifications: RNs hired prior to 7/1/2019 with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN, however, they are required to complete the BSN within 5 years of job entry date. A Utilization Review or Case Management Certification required within 12 months of hire. 3 years of hospital clinical experience preferred. Excellent written, interpersonal communication and negotiation skills. Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently. Strong analytical, data management and computer skills. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Current working knowledge of payer and managed care reimbursement preferred. Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. Knowledgeable in local, state, and federal legislation and regulations. Ability to tolerate high volume production standards. Minimum Required Experience: Job: NursingPrimary Location: Boca RatonOrganization: Boca Raton Regional HospitalSchedule: Per DiemJob Posting: Jun 7, 2021, 11:22:52 AMUnposting Date: Ongoing

Keywords: Baptist Health South Florida, Boca Raton , Pool Utilization Review RN, Case Management, Per Diem, 8A-4:30P, Executive , Boca Raton, Florida