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Coordinator-RN Utilization-3p-11p

North Mississippi Medical Center -
Tupelo, MS

Apply Now

Job Details

Full-time

Benefits

On-the-job training

Qualifications

RN License
Working with pediatric populations
Working with geriatric patients
State healthcare regulations
Pediatrics
Associate's degree
Associate Degree in Nursing
Geriatrics
Cross-functional communication

Full Job Description

Coordinator-RN Utilization-3p-11p

Job ID: 000FWI

Tupelo

Professionals - UTILIZATION MANAGEMENT

Full Time - Day

Posting Description

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.

Job Description

Essential Functions

List major areas of responsibility and briefly what the person does in each area.

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

Know How

Job Knowledge:

Specify required education, licensure/certification, prior experience, skill behavior, equipment operation, type and duration of on-the-job training, patient population to be served, etc.

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

Requirements

The following are requirements in addition to any stated in the above description.

Licenses

You must have the following licenses to apply:

Registered Nurse

Education

You must have the following education to apply:

Associates of Nursing

You must have a Associates or higher

Apply Now

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nurse coordinator jobs in sherman, ms

Coordinator-RN Utilization-3p-11p

MDS Clinical Care Coordinator LPN/RN - Tupelo Community Care Center

Nurse for Assisted Living (LPN FT)

Nursing Assistant, Unit Coordinator, & Monitor Tech, Chest Pain Unit

Nursing Assistant & Unit Coordinator, 2 West

Registered Nurse - Hospice - PRN

Nursing Assistant, Unit Coordinator, & Monitor Tech, 2 West

Nurse for Assisted Living (LPN FT)

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Coordinator-RN Utilization-3p-11p

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