RN Coordinator-Utilization

We believe a career is more than just a career — it's a calling. Our teammates' "True North" is what calls them to health care; it’s their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love.

Department

10007915 Utilization Management

Work Shift

Variable shift, Monday thru Friday primarily with some weekend work

Job Description

The RN Utilization Coordinator at North Mississippi Health Services is responsible for coordinating and performing various tasks related to utilization management and case management services. They work with physician services, perform clinical reviews, educate care team members, and ensure compliance with regulatory guidelines.

JOB FUNCTIONS

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.

Educations

• 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.

Reporting/Recordkeeping

• Updates patient’s medical records as required.
• Shares medical necessity documentation with payers to facilitate reimbursement.

Regulation

• Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.

Knowledge Skills and Abilities

• Excellent organizational and communication (written and verbal) skills; required
• Knowledge of various payer sources, federal/state laws/regulations, and cost containment; required
• Excellent interpersonal skills; required
• Demonstrates ability to care for a patient population from pediatric to geriatric; required
• Works independently as well as in a team setting
• Resolves problems/issues related to patient outcomes
• Assists with departmental Performance Improvement (PI)
• Assures compliance with regulatory guidelines and applicable laws/statues
• Must have excellent written and verbal communication skills
• Must reflect a positive, caring attitude toward clients, patients, staff and the public we serve

Physical Demands

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Standing. Constantly
• Walking. Constantly
• Sitting. Occasionally
• Lifting/Carrying. Frequently 50 lbs
• Pushing/Pulling. Frequently
• Climbing. Occasionally
• Balancing. Occasionally
• Stooping/Kneeling/Bending. Occasionally
• Reaching/Over Head Work. Occasionally
• Grasping. Frequently
• Speaking. Constantly
• Hearing. Constantly
• Repetitive Motions. Constantly
• Eye/Hand/Foot Coordination. Frequently

Salary Range

$65,166.40-$81,463.20

Education

Associate’s Degree | Nursing | Required Bachelor’s Degree | Nursing | Not Required

Certifications

Accredited Case Manager (ACM) - ACM, Registered Nurse (MS) - MS Board of Nursing