- 4/10hr shifts (630am - 5pm / 7am - 530pm) with a weekend rotation
Monitor admissions and perform initial and continued stay medical necessity reviews.
- Maintain thorough knowledge of payer guidelines and regulatory requirements and manages concurrent and pre-bill denials to prevent loss of reimbursement.
- Collaborate and communicate with the multidisciplinary care team regarding patient status and concurrent denials.
- Build relationships to promote interdisciplinary collaboration.
- Ensure requested clinical information is communicated, monitors daily discharge reports, and follows up with insurance carriers to obtain complete authorization.
Knowledge, Skills, and Abilities:- Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations.
- Demonstrates knowledge of the principles of growth, development, and disease states as it relates to the different life cycles.
- Ability to understand differences between notification, reference, and authorization numbers.
- Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.
- Accesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff.
Education:- Associate's of Nursing [Required]
- Bachelor's of Nursing [Preferred]
Work Experience:- 3+ years clinical nursing [Required]
- 5+ years clinical nursing in an acute care setting [Preferred]
- Experience working in electronic health records [Preferred]
- Utilization Management or Case Management [Preferred]
Licenses and Certifications:- Registered Nurse (RN) [Required] AND
- Accredited Case Manager (ACM) [Preferred] OR
- Certified Case Manager (CCM) [Preferred]
Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/msy4mja2
Pay Range:$68,132.50 - $119,520.35
Background Screening Requirement (Florida Law)Certain positions are subject to
Florida Level 2 background screening, including fingerprinting, as required by state law.
Applicants may review general information about Florida's background screening requirements at the
Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/
