RN Utilization Coordinator, Case Management, FT, Days, NMMC Gilmore Amory

Posting Description At North Mississippi Health Services, our mission is to “continuously improve the health of the people of our region.” Our vision is to “provide the best patient and family-centered care and health services in America.” We believe that fulfilling our mission and vision calls us to embrace the best people that form incredible connections to our patients and families. We take pride in celebrating everything that makes you uniquely you – your talents, your perspectives, and your passions. At North Mississippi Health Services, we believe in connecting your passion with a purpose. When you are part of our team, you know what connected feels like. #WhatConnectsYou Job Description Essential 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 Requirements: 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