Registered Nurse – Utilization Review, Case Management

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🔥 46 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $73.9k - $98.2k / year

⏱ Part Time

🟡 Mid-level

🟠 Senior

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Baptist Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Baptist Health is the region's largest not-for-profit healthcare organization in South Florida. It operates 12 hospitals, more than 29,000 employees, 4,500 physicians, and roughly 200 outpatient centers, urgent care facilities, and physician practices across Miami-Dade, Monroe, Broward, and Palm Beach counties. The system includes renowned centers of excellence in cancer, heart and vascular, brain and spine, and orthopedic care, and is supported by philanthropy and a faith-based mission. Baptist Health emphasizes clinical quality, patient safety, staff development, and community-oriented care.

📋 Description

• 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. • Accountability for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. • Screens pre-admission, admission process using established criteria for all points of entry. • Facilitates communication between payers, review agencies, healthcare team. • Identifies delays in treatment or inappropriate utilization and serves as a resource. • Coordinates communication with physicians. • Identifies opportunities for expedited appeals and collaborates to resolve payer issues. • Ensures/Maintains effective communication with Revenue Cycle Departments.

🎯 Requirements

• Associates. • MCG Care Guidelines Specialist. • Registered Nurse. • RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) 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 3 years of job entry date. • MCG Specialist Certification ISC/HRC required within 12 months of job entry date. • 3 years of Nursing 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.

🏖️ Benefits

• Career growth and development opportunities, with clear pathways and ongoing support • Comprehensive health and wellness resources that go beyond traditional benefits • A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs • Tuition reimbursement to support continued learning and advancement • And so much more