When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
32 hpw; 8-hr shifts (7a-3:30p flex); rotating weekends and holidays
Job Description:
Duties/Responsibilities:
- Reviews admission data to establish the appropriate level of care using Interqual criteria.
- Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient.
- Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of treatments/procedures and to optimize the potential for reimbursement.
- Collaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process.
- Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay.
- Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls.
- Collects and compiles data as required.
It is understood that this is a summary of key job functions and does not include every detail of the job that may reasonably be required.
Education/Experience Required:
- Current MA RN licensure
- Bachelor’s Degree in Nursing or advanced degree in healthcare preferred.
- Three years recent, broad clinical experience in the hospital setting
- Experience with utilization management within the last 3 years required
- An understanding of the severity of an array illnesses, intensity of service, and care coordination needs
- Ability to identify appropriateness of patients admission and level of care needs (inpatient & observation) utilizing Interqual criteria
- Knowledged of Interqual required; Allscripts preferred
- Strong interpersonal and negotiation skills demonstrated by a positive attitude, pleasant, professional and cooperative demeanor with patients, physicians, colleagues and insurance companies
- Knowledge of government and insurance company reimbursement policies in regards to admission criteria, treatment and length of stay
- Ability to work independently
Registration/Certification:
- Current MA RN licensure
Pay Range:
$36.41 – $74.59
This position is covered by a collective bargaining agreement. The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. The pay range for this position is established and governed by the terms of the applicable collective bargaining agreement. Employees hired into this position will receive compensation consistent with the terms of the applicable collective bargaining agreement.
