What are the responsibilities and job description for the RN Utilization Coordinator, Case Management, FT, Days, NMMC Gilmore Amory position at North Mississippi Medical Center System?
Gilmore Amory
CASE MANAGEMENT
Full Time - Day
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
**_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
Registered Nurse
Associates
CASE MANAGEMENT
Full Time - Day
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
Requirements:
Licenses
You must have the following licenses to apply:Registered Nurse
Education
You must have the following education to apply:Associates
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