Job Details

Denial & Appeals Coord, Utilization Management, FT, 8:30A-5P

Job: Nursing
Facility: Homestead Hospital,
Primary Location: Homestead
Job Schedule: Full-time
Job ID: 82442

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About Baptist Health South Florida:

Baptist Health South Florida ranked #25 on the list of 2018 Fortune 100 Best Companies to Work For! This is the 18th time Baptist Health has been named to the prestigious list and was listed #1 in diversity overall , #2 in the state of Florida, and #3 in healthcare organizations on the list. 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 19,500 employees working across ten hospital campuses, more than 40 physician practices and 50 outpatient and urgent care facilities throughout Monroe, Miami-Dade, Broward and Palm Beach counties. 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:

Functions as a lead member of the Care Coordination team to ensure high quality patient care, appropriate length of stay, efficient resource utilization and ensure reimbursement for services rendered. Collaborates with all members of the health care team to prevent insurance denials and discharge delays.  The focus is on care appropriateness and quality, specifically decreasing inappropriate admissions, avoidable days and readmissions.  Serves as a resource to the hospital for utilization management issues.

Qualifications:

Minimum required experience 3 years.  Bachelor’s degree in Nursing (BSN) preferred.  RN’s hired with an Associate’s Degree have 3 years to complete a BSN.  Current Florida RN license required. Hospital clinical experience, 3 years UR/CM experience, written and verbal communication and interpersonal skills, and knowledge of reimbursement principles. Certified Case Manager, Certified Professional Health Management, MCG Certification or eligible to pursue within one year.

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