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RN-Pre Certification Authorization - HS Centralized Patient Access Ctr Corporate

Job ID: 9046
Job Category: Nurse RN
Job Type: Clinical Nurse
Work Type: Full Time
Work Schedule: Days
Facility: Centralized Patient Access Center
Location: Collierville, TN

Summary

Coordinates precertification/authorization services for patients across the continuum of care, promoting quality care, and effective utilization of resources. Provides leadership when dealing with patient preauthorization functions, including inpatient and outpatient services. Coordinates efforts between departments to ensure accurate precertification, resulting in timely billing of claims. Some overtime and call back may be required. Reports to the Director of CPAC. Performs other duties as assigned.

Responsibilities

  • Assesses and evaluates clinical and financial information available and recommends the most appropriate delivery of services, including level of care in order to optimize resource consumption and reimbursement.
  • Precertifies patient care services that require precertification, in a timely, efficient manner, in order to optimize reimbursement for the patient as well as health care providers.
  • Communicates recommendations, clinical information, and fiscal information to appropriate internal and external customers in order to facilitate optimal delivery of services and customer satisfaction.
  • Reviews orders for accuracy and medical necessity to facilitate delivery of services and appropriate reimbursement.
  • Addresses issues identified with retrospective reviews for all payers.
  • All outpatient procedures will be timely precerted when applicable.
  • Works to improve the QI/PI process.
  • Assumes responsibility for personal growth and development by attendance and / or participation in inservices and continuing education programs.
  • Completes assigned goals.


Requirements, Preferences and Experience

Experience

Preferred: Prefer experience in utilization/case management.

Minimum: 3 years of clinical experience.

Licensure, Registration, Certification

Preferred: CCM;ACM

Minimum: RN

Special Skills

Preferred: Prefer certification in CPHQ, CCM, ACM

Minimum: Advanced communication, conflict management, organizational and planning skills; advanced computer literacy skills.

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:
  • Competitive salaries
  • Paid vacation/time off
  • Continuing education opportunities
  • Generous retirement plan
  • Health insurance, including dental and vision
  • Sick leave
  • Service awards
  • Free parking
  • Short-term disability
  • Life insurance
  • Health care and dependent care spending accounts
  • Education assistance/continuing education
  • Employee referral program

Job Summary:
Position: 6903 - RN-Pre Certification Authorization
Facility: Centralized Patient Access Center
Department: HS Centralized Patient Access Ctr Corporate
Category: Nurse RN
Type: Clinical Nurse
Work Type: Full Time
Work Schedule: Days
Location: US:TN:Collierville
Located in the Memphis metro area
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