<p>A Brief Overview This position is responsible for ensuring referrals and precertification of patient admit has been completed according to established protocol. The Lead Precertification Nurse Coordinator will primarily be responsible for obtaining precertification for extended care admissions # procedures or testing requiring precert, communicating to patients, external medical offices and internal staff regarding policies and guidelines, sends clinical updates for continued stay reviews and conducts daily investigations to validate insurance eligibility. This role will also require Clinical Liaison and Case Management continuous communication. What you will do Verifies payer for patients deemed appropriate for long-term acute care. Researches potential alternate payer availability. Provides monthly re-verification of in house patient benefits. Assist ECH CM, HIM, and Admissions Access with determination of benefits coverage and third party administrator Responsible for submitting pertinent clinical data to pay along with ICD10; HCPCS; DRG if required. Provides education and information to medical and clinical staff as well as patients and family. Assists in marketing the Extended Care Hospital by attending and presenting information at community events, community based groups, hospitals, nursing homes and physician groups to increase awareness, promote visibility, and referrals to the facility for services. Maintains patient medical records; documents patient status and care given. Utilizes patient computer systems to enter and retrieve data. Confers and works collaboratively with patient/family/hospital staff regarding all aspects of patient needs in a customer responsive and courteous manner, in compliance with iRESPECT Standards and promoting patient/customer satisfaction. Completes required continuous training and education, including department specific requirements. Maintains professional credentials and education necessary to keep abreast and maintain a current knowledge of precertification and clinical principles, concepts and techniques, best practices and current trends. Attends staff meetings, all mandatory in-service and additional continuing education as required. Contributes to the annual review of unit-based scope statement and determination of important aspects of care for clinical review. Assists in the development of indicators, thresholds, study methods, and data collection as assigned. Responds to problems/opportunities to improve care. Supports and is involved in the organization#s Performance Improvement initiatives. Participates in and maintains competencies required for the position. Utilizes workflow tools for consistency and transparency of precert process. Provides professional clinical care in accordance with patient care policies and procedures, demonstrated competencies, and with consideration given to risk management, infection control practices, and patient safety practices. Utilizes computer to enter and retrieve medical/patient information; generate statistics, computations, tables or charts. Maintains confidentially of all information in accordance with hospital, HIPAA, compliance and other regulatory requirements. Maintains a clean, orderly, safe environment for patients and personnel. Adheres to established policies, compliance/quality improvement, and safety, environment and infection control standards. Prepares and maintains required records, reports and files for administrative and compliance purposes. Utilizes computer and information systems to enter format and retrieve data, generate statistics, computations, tables, charts and graphs. Qualifications Graduate of an approved nursing school/program. Required Clinical licensure or permit to work in state of TN Upon Hire Required and CCM - Certified Case Manager Upon Hire Preferred and Cardiopulmonary Resuscitation (CPR) Upon Hire Required or BCLS - Basic Life Support Upon Hire Required Minimum 3 years experience pre-certification experience. Required and Liaison # marketing experience. Required and Insurance Case manager working relationships a plus. Preferred Physical Demands Standing - Occasionally Walking - Occasionally Sitting - Constantly Lifting - Rarely Carrying - Rarely Pushing - Rarely Pulling - Rarely Climbing - Rarely Balancing - Rarely Stooping - Rarely Kneeling - Rarely Crouching - Rarely Crawling - Rarely Reaching - Rarely Handling - Occasionally Grasping - Occasionally Feeling - Rarely Talking - Constantly Hearing - Constantly Repetitive Motions - Frequently Eye/Hand/Foot Coordination - Frequently Regional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.</p> <p>A Brief Overview</p> <p>This position is responsible for ensuring referrals and precertification of patient admit has been completed according to established protocol. The Lead Precertification Nurse Coordinator will primarily be responsible for obtaining precertification for extended care admissions & procedures or testing requiring precert, communicating to patients, external medical offices and internal staff regarding policies and guidelines, sends clinical updates for continued stay reviews and conducts daily investigations to validate insurance eligibility. This role will also require Clinical Liaison and Case Management continuous communication.</p> <p>What you will do</p> <ul> <li>Verifies payer for patients deemed appropriate for long-term acute care. </li><li>Researches potential alternate payer availability. </li><li>Provides monthly re-verification of in house patient benefits. </li><li>Assist ECH CM, HIM, and Admissions Access with determination of benefits coverage and third party administrator </li><li>Responsible for submitting pertinent clinical data to pay along with ICD10; HCPCS; DRG if required. </li><li>Provides education and information to medical and clinical staff as well as patients and family. </li><li>Assists in marketing the Extended Care Hospital by attending and presenting information at community events, community based groups, hospitals, nursing homes and physician groups to increase awareness, promote visibility, and referrals to the facility for services. </li><li>Maintains patient medical records; documents patient status and care given. Utilizes patient computer systems to enter and retrieve data. </li><li>Confers and works collaboratively with patient/family/hospital staff regarding all aspects of patient needs in a customer responsive and courteous manner, in compliance with iRESPECT Standards and promoting patient/customer satisfaction. </li><li>Completes required continuous training and education, including department specific requirements. </li><li>Maintains professional credentials and education necessary to keep abreast and maintain a current knowledge of precertification and clinical principles, concepts and techniques, best practices and current trends. </li><li>Attends staff meetings, all mandatory in-service and additional continuing education as required. </li><li>Contributes to the annual review of unit-based scope statement and determination of important aspects of care for clinical review. </li><li>Assists in the development of indicators, thresholds, study methods, and data collection as assigned. </li><li>Responds to problems/opportunities to improve care. </li><li>Supports and is involved in the organization's Performance Improvement initiatives. </li><li>Participates in and maintains competencies required for the position. </li><li>Utilizes workflow tools for consistency and transparency of precert process. </li><li>Provides professional clinical care in accordance with patient care policies and procedures, demonstrated competencies, and with consideration given to risk management, infection control practices, and patient safety practices. Utilizes computer to enter and retrieve medical/patient information; generate statistics, computations, tables or charts. Maintains confidentially of all information in accordance with hospital, HIPAA, compliance and other regulatory requirements. </li><li>Maintains a clean, orderly, safe environment for patients and personnel. Adheres to established policies, compliance/quality improvement, and safety, environment and infection control standards. </li><li>Prepares and maintains required records, reports and files for administrative and compliance purposes. Utilizes computer and information systems to enter format and retrieve data, generate statistics, computations, tables, charts and graphs. </li></ul> <p>Qualifications</p> <ul> <li>Graduate of an approved nursing school/program. Required </li><li>Clinical licensure or permit to work in state of TN Upon Hire Required and </li><li>CCM - Certified Case Manager Upon Hire Preferred and </li><li>Cardiopulmonary Resuscitation (CPR) Upon Hire Required or </li><li>BCLS - Basic Life Support Upon Hire Required </li><li>Minimum 3 years experience pre-certification experience. Required and </li><li>Liaison & marketing experience. Required and </li><li>Insurance Case manager working relationships a plus. Preferred </li></ul> <p>Physical Demands</p> <ul> <li>Standing - Occasionally </li><li>Walking - Occasionally </li><li>Sitting - Constantly </li><li>Lifting - Rarely </li><li>Carrying - Rarely </li><li>Pushing - Rarely </li><li>Pulling - Rarely </li><li>Climbing - Rarely </li><li>Balancing - Rarely </li><li>Stooping - Rarely </li><li>Kneeling - Rarely </li><li>Crouching - Rarely </li><li>Crawling - Rarely </li><li>Reaching - Rarely </li><li>Handling - Occasionally </li><li>Grasping - Occasionally </li><li>Feeling - Rarely </li><li>Talking - Constantly </li><li>Hearing - Constantly </li><li>Repetitive Motions - Frequently </li><li>Eye/Hand/Foot Coordination - Frequently </li></ul> <p>Regional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.</p>