Description
Summary
Coordinates preadmission and outpatient registration services for patients across the continuum of care, promoting quality care, and effective utilization of resources. Provides leadership when dealing with patient preadmission functions, including inpatient and outpatient services. Reviews, researches and coordinates efforts between departments to ensure accurate, timely billing of claims hitting for Caremedic LCD edits. Evaluates, assesses, plans and facilitates a plan of care. Some overtime and call back may be required. Reports to the Director of Case Management. Performs other duties as assigned.
Responsibilities
+ Assesses and evaluates clinical and financial information available and recommends the most appropriate delivery of services, including level of care in order to optimize resource consumption and reimbursement.
+ Precertifies patient care services that require precertification, in a timely, efficient manner, in order to optimize reimbursement for the patient as well as health care providers.
+ Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
+ Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement.
+ Addresses issues identified with retrospective reviews for all payers.
+ Reviews Caremedic claims in LCD status for medical necessity.
+ Works to improve the QI/PI process.
+ Assumes responsibility for personal growth and development by attendance and / or participation in inservices and continuing education programs.
+ Completes assigned goals.
Requirements, Preferences and Experience
Experience
Preferred: Prefer experience in utilization/case management.
Minimum: 3 years of clinical experience.
Licensure, Registration, Certification
Preferred: CCM;ACM
Minimum: RN
Special Skills
Preferred: Prefer certification in CPHQ, CCM, ACM
Minimum: Advanced communication, conflict management, organizational and planning skills; advanced computer literacy skills.
About Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.
At Baptist, We Offer:
+ Competitive salaries
+ Paid vacation/time off
+ Continuing education opportunities
+ Generous retirement plan
+ Health insurance, including dental and vision
+ Sick leave
+ Service awards
+ Free parking
+ Short-term disability
+ Life insurance
+ Health care and dependent care spending accounts
+ Education assistance/continuing education
+ Employee referral program
Job Summary:
Position: 3307 - RN-Pre Admission
Facility: BMH - North Mississippi Oxford Hospital
Department: NM Case Mgmt Administration BMH North MS
Category: Nurse RN
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Location: US:MS:Oxford
Located in the Oxford, MS metro area REQNUMBER: 25079
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