Job Details

Utilization Review RN 1, Performance Improvement, FT, 7A-3:30P

Job: Nursing
Facility: Homestead Hospital,
Primary Location: Homestead
Job Schedule: Full-time
Job ID: 82429

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About Baptist Health South Florida:

Baptist Health South Florida is once again one of the 2018 Fortune 100 Best Companies to Work For! This is the 18th time Baptist Health has been named to the prestigious list and is the only healthcare provider in the state to be ranked.  We have also been recognized for being among the best healthcare providers in the nation by U.S. News & World Reports in its 2017-2018 Best Hospitals report.

 

Baptist Health South Florida is the region’s largest not-for-profit healthcare organization with more than 18,000 employees working across ten hospital campuses and more than 50 outpatient facilities throughout Miami-Dade, Monroe, Broward, and Palm Beach counties. In 2016 we welcome the newest weapon in the fight against cancer, the world-class Miami Cancer Institute and proton therapy center. Everything we do at Baptist Health, we do to the best of our ability. That includes supporting our team with extensive training programs, millions of dollars in tuition assistance, comprehensive benefits and more. Working within our award-winning culture means getting the respect and support you need to do your best work ever. Find out why this is the best place to be your best!

Job 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:

Minimum required experience 3 years.  Associates degree in Nursing required. RNs hired with an Associate Degree are required to complete BSN within 5 years of hire. Current Florida RN license required. 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.

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