Utilization Coordinator- Case Management, FT, 7a-3:30p, M-F
North Mississippi Medical Center
Tupelo, MS
Full-time
Social Service
Posted on December 10, 2021
Essential Functions
Coordinates:
Coordinates:
- Consults with physician services
- Utilizes clinical diagnostics, physician documentation and non-physician clinical guidelines to facilitate status determination of inpatient, outpatient or outpatient observation.
- Coordinates final status with admitting and attending physicians
- Performs initial and concurrent clinical reviews as indicated by payer and patient clinical needs
- Inpatient and/or outpatient notification and precertification of services to payers
- Facilitates peer to peer, written reconsiderations or appeals throughout all denial cycle as appropriate
- Facilitates appropriate observation utilization
- Consults with patient financial services
- Provides education and literature to physician services regarding IPPS and OPPS
- Educates physicians and other care team member on level of care criteria and other third party payer requirements
- Updates patient's medical records as required
- Shares medical necessity documentation with payers to facilitate reimbursement
- Adheres to NMHS/NMMC Policies/Procedures/Guidelines
- Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues
- Associates Degree in Nursing, required; Bachelor's Degree preferred
- Licensed as a Registered Nurse by the Mississippi Board of Nursing; required
- Minimum of 5 years clinical and/or healthcare experience; required
- Excellent organizational and communication (written and verbal) skills; required
- Knowledge of various payer sources, federal/state laws/regulations, and cost containment; required
- Certified as an Accredited Case Manager (ACM); desirable
- Excellent interpersonal skills; required
- Demonstrates ability to care for a patient population from pediatric to geriatric; required
- Weekend rotation every 8 weeks