Utilization Review RN

Sign-On Bonus: Up to $5,000
Baptist Health has a commitment to strengthening the compassionate care we provide. With the addition of Boca Raton Regional Hospital, Baptist Health is able to provide the Palm Beach community expanded access to healthcare services.

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. The Hospital is now a part of Baptist Health South Florida is the region's largest not-for-profit healthcare organization with more than 23,000 employees working across 11 hospital campuses and more than 100 outpatient facilities throughout Miami-Dade, Monroe, Broward, and Palm Beach counties. In 2016 we welcomed the newest weapon in the fight against cancer, the world-class Miami Cancer Institute and proton therapy center.

Baptist Health South Florida is once again one of the 2020 Fortune 100 Best Companies to Work For! This is the 20th time Baptist Health has been recognized on the list. We have also been recognized for being among the best healthcare providers in the nation by U.S. News & World Reports in its 2020-2021 Best Hospitals report and have been honored as one of PEOPLE's 2020 50 Companies That Care by PEOPLE magazine and Great Place to Work.

Everything we do at Baptist Health, we do to the best of our ability. That includes supporting our team with extensive training programs, millions of dollars in tuition assistance, comprehensive benefits and more. Working within our award-winning culture means getting the respect and support you need to do your best work ever. Find out why this is the best place to be your best!
Description:

The Utilization Review RN is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. Accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens preadmission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, 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. Ensures/Maintains effective communication with Revenue Cycle Departments

Qualifications:

BSN Degree, Current State of Florida RN License and a Utilization Review or Case Management Certification required within 12 months of hire. 3 years of hospital clinical experience preferred.

EOE
800 Meadows Rd Boca Raton, FL 33486CategoryNursingBoca Raton Regional HospitalPosted Date:01/15/2021Job Id109098