19 days old

RN Utilization Review Psych Hosptial Services FT Days Brookwood BMC

Brookwood Baptist Medical Center
Birmingham, AL 35201
  • Jobs Rated
    118th

Summary

The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis. This position integrates national standards for case management scope of services including:
Utilization Management services supporting medical necessity and denial prevention
Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient
Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits

Responsibilities
  • Accurate medical necessity screening and submission for Physician Advisor review
  • Securing and documenting authorization for services from payers
  • Managing concurrent disputes
  • Collaborating with payers, physicians, office staff and ancillary departments
  • Timely, complete and concise documentation in the Tenet Case Management documentation system
  • Maintenance of accurate patient demographic and insurance information
  • Identification and documentation of potentially avoidable days
  • Identification and reporting over and underutilization

    Qualifications:

    Education

    Preferred: BSN

    Experience

    Required: Two (2) years hospital acute or behavioral health patient care experience.
    Preferred: One (1) year hospital acute or behavioral health case management.

    Certifications

    Required: Active and valid RN license.
    Preferred: Accredited Case Manager (ACM).

    Job: Psychiatric/Behavioral
    Primary Location: Birmingham, Alabama
    Facility: Brookwood Medical Center
    Job Type: Full-time
    Shift Type: Days

    Categories

    Jobs Rated Reports for Registered Nurse

    Posted: 2019-10-02 Expires: 2019-11-01

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RN Utilization Review Psych Hosptial Services FT Days Brookwood BMC

Brookwood Baptist Medical Center
Birmingham, AL 35201

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Registered Nurse
118th2018 - Registered Nurse
Overall Rating: 118/220
Median Salary: $70,000

Work Environment
Poor
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Stress
High
173/220
Growth
Good
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