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Coordinator-RN Utilization-3p-11p

Full Time Nursing

Job Description

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.

Essential FunctionsList 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

Qualifications

Education

You must have the following education to apply:

Associates of Nursing

You must have a Associates or higher

Schedule

Day
North Mississippi Health Services
About North Mississippi Health Services

North Mississippi Health Services (NMHS) is a diversified regional health care organization serving 24 counties in north Mississippi and northwest Alabama and is one of the largest employers in Mississippi with over 6,900 employees. NMHS covers a broad range of acute diagnostic and therapeutic services offered through North Mississippi Medical Center (NMMC) in Tupelo, Community Hospital System, and North Mississippi Medical Clinics.  NMHS strives to improve the health for people in this region by providing conveniently accessible and cost-effective healthcare of the highest quality. 

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