It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
The 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 (mail/log). The Coordinator will analyze denials and appeals for patterns and trends. Provides reports and researches trends in denials. Educates regarding documentation to support the patients admission (from the ED) and hospitalization stay. She/he will serve as on-site appeals coordinator and responds to retrospective denials. Discharge planning, clinical reviews and unit coverage as staffing warrants. She/he will be responsible for timely facilitation and coordination of patient care for a specific patient population or area of assignment. The job responsibilities include working effectively with the interdisciplinary team so as to plan and implement an individualized program of care that promotes high quality, efficient and cost effective care. 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. Participate in committees and special projects.
Requirements:
-Bachelor's degree required (Masters Degree preferred).
-Current registration in New York State as an RN, Diploma and Licensure required.
-PRI and Screen certificate required.
-Must have at least 5 years of clinical experience as a Registered Nurse and supervisory experience with utilization review/management
-Interqual knowledge/experience preferred.
-Knowledge of Microsoft Word and Excel required.
-SAVVY, Invision, RAX experience required.
Days w/ eo wknd & hols; 8a-4p
Salary Range: $62.339/hr - $71.223/hr (Commensurate with Experience)
Employment Non-Discrimination: Richmond University Medical Center is committed to equality of opportunity in all aspects of employment and provides full and equal employment opportunities to all employees and potential employees without regard to race, color, national origin, religion, gender identity, sex, sexual orientation, pregnancy, childbirth and related medical conditions and needs including lactation accommodations, physical or mental disability, age, immigration or citizenship status, veteran or active military status, genetic information, or any other legally protected status.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Skills Required
- Bachelor's degree
- Master's degree
- Current New York State RN registration, diploma and licensure
- PRI and Screen certificate
- At least 5 years clinical experience as a Registered Nurse and supervisory experience with utilization review/management
- Interqual knowledge/experience
- Knowledge of Microsoft Word and Excel
- Experience with SAVVY, Invision, RAX
What We Do
Richmond University Medical Center (RUMC) is an award-winning, not-for-profit teaching hospital serving Staten Island and the Greater New York City area. As a full-service healthcare facility and Level 1 Trauma Center, it provides comprehensive inpatient and outpatient care, including emergency, trauma, surgery, pediatrics, and behavioral health services, dedicated to delivering premier quality patient care to its community.
