<p>The purpose of this position 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. They are accountable for a designated patient caseload and provides intervention, 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, 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 to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments. Estimated salary range for this position is $35.51 - $46.16 / hr depending on experience.</p> <p>Degrees:</p> <ul> <li>Associates. </li></ul> <p>Licenses & Certifications:</p> <ul> <li>MCG Care Guidelines Specialist. </li><li>Registered Nurse. </li></ul> <p>Additional Qualifications:</p> <ul> <li>RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN. </li><li>however, they are required to complete the BSN within 3 years of job entry date. </li><li>MCG Specialist Certification ISC/HRC required within 12 months of job entry date. </li><li>3 years of Nursing experience preferred. </li><li>Excellent written, interpersonal communication and negotiation skills. </li><li>Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently. </li><li>Strong analytical, data management and computer skills. </li><li>Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. </li><li>Current working knowledge of payer and managed care reimbursement preferred. </li><li>Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families. </li><li>Knowledgeable in local, state, and federal legislation and regulations. </li><li>Ability to tolerate high volume production standards. </li></ul> <p>Minimum Required Experience:</p> <ul> <li>3 Years of Nursing experience required </li><li>1 Year of Utilization Review experience required </li></ul>