Pool Utilization Review Registered Nurse, Case Management, Per Diem, Day Shift Varies

Baptist Health South Florida • Per Diem • Boca Raton, Florida, USA • 1w ago

Baptist Health South Florida is the region’s largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. Baptist Health is supported by philanthropy and committed to its faith-based charitable mission of medical excellence.

Our mission, vision, and values make us who we are at Baptist Health and are at the center of everything we do. At Baptist Health, we positively impact the human experience for patients, employees, and physicians. Our success comes from a culture of quality and dedication that is instilled into every member of the Baptist Health family.

This year, and for 24 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, based on employee feedback. We’ve also been recognized as one of America’s Most Innovative Companies and People Magazine included us in 50 Companies That Care. Based on the U.S. News & World Report 2023-2024 Best Hospital Rankings, Baptist Health is the most awarded healthcare system in South Florida, with its hospitals and institutes earning 45 high-performing honors.

But really, the reason we’re excited to come to work is the people.

Working together, we form personal connections with our colleagues that are stronger than most of us have experienced at other jobs. We develop caring relationships with our patients and their families that go beyond just delivering healthcare. After all, we know what it’s like to be in their shoes. Many of us have been patients here and have had family members as patients here. We’re committed to delivering quality care in the most compassionate way possible because we feel a personal stake in the outcomes. When it comes to caring for people, we’re all in.

Boca Raton Regional Hospital is an advanced tertiary medical center with 400 beds and is a recognized leader in Cardiovascular Care, Oncology, Women's Health, Orthopedics, Emergency Medicine and the Neurosciences, all of which offer state-of-the-art diagnostic and imaging capabilities.

Description:

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical, financial and resource utilization. Coordinates with healthcare Team for optimal efficient patient outcomes, while decreasing length of stay and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention and coordination to decrease avoidable delays denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry, Facilitates communication between payers, review agencies and healthcare team, Identify delays in treatment or inappropriate utilization and serves as a resource, Coordinates communication with physicians, Identify opportunities for expedited appeals and collaborates resolve payer issues and ensures, maintains effective communication with Revenue Cycle Departments. Estimated pay range for this position is $45.00 / hour depending on shift as applicable.

Qualifications:

Degrees:

Associates.

Licenses & Certifications:

Registered Nurse.

Additional Qualifications:

RNs hired prior to 2-2012 with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN, however, required to complete the BSN within 5 years of hire.
3 years of hospital clinical experience preferred.
Excellent written, interpersonal communication and negotiation skills.
Strong critical thinking skills and the ability to perform clinical chart review abstract information efficiently.
Strong analytical, data management and computer skills.
Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
Current working knowledge of payer and managed care reimbursement preferred.
Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.
Knowledgeable in local, state, and federal legislation and regulations, and ability to tolerate high volume production standards.

EOE

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