Registered Nurse Utilization Review, Case Management, Part Time, Weekend Days

$72,779 - $96,796/Yr

Baptist Health - Tavernier, FL

Part-time - Mid Level

Tavernier, FL

10,001+ employees

Hospitals

About the position

The Registered Nurse Utilization Review position at Baptist Health South Florida focuses on conducting initial, concurrent, and retrospective chart reviews for clinical financial resource utilization. The role aims to coordinate with the healthcare team to optimize patient outcomes, reduce length of stay, and prevent delays and denied days. The nurse will manage a designated patient caseload, facilitate communication between payers and the healthcare team, and identify opportunities for expedited appeals and resolution of payer issues.

Responsibilities

• Conduct initial, concurrent, and retrospective chart reviews for clinical financial resource utilization.
• Coordinate with the healthcare team to optimize patient outcomes and decrease length of stay.
• Screen pre-admission and admission processes using established criteria for all points of entry.
• Facilitate communication between payers, review agencies, and the healthcare team.
• Identify delays in treatment or inappropriate utilization and serve as a resource.
• Coordinate communication with physicians regarding patient care.
• Identify opportunities for expedited appeals and collaborate to resolve payer issues.
• Maintain effective communication with Revenue Cycle Departments.

Requirements

• Associates degree in Nursing required.
• Registered Nurse license required.
• MCG Care Guidelines Specialist certification 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 ability to perform clinical/chart review efficiently.
• Strong analytical, data management, and computer skills.
• Organizational and time management skills to prioritize multiple tasks.
• Current working knowledge of payer and managed care reimbursement preferred.
• Ability to work independently and exercise sound judgment in interactions with the healthcare team and patients/families.
• Knowledgeable in local, state, and federal legislation and regulations.

Nice-to-haves

• Experience in Case Management or Home Health preferred.

Benefits

• Competitive salary range of $72,779.20 - $96,796.34 per year depending on experience.