Role OverviewThe Clinical Resource Manager Coordinator will act as a resource to the Case Managers and other disciplines relative to concurrent and retrospective denials of payments. She/he will maintain payer database and updates reports as necessary.
What You Will Do
Provides reports and researches trends in denials. Educates regarding documentation to support the patients admission (from the ED) and hospitalization stay. Responds to retrospective denials.
Why It Might Be a Fit
Must assess the patient needs utilizing established standards/interqual, and other approved clinical guidelines. Ongoing communication with third party representatives and facilitate care that meets established patient care needs while optimizing care and reimbursement.
Requirements
- Bachelor's degree
- Current registration in New York State as an RN
- PRI and Screen certificate
- At least 5 years of clinical experience as a Registered Nurse and supervisory experience with utilization review/management
- Interqual knowledge/experience
- Knowledge of Microsoft Word and Excel
- SAVVY, Invision, RAX experience
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