Overview and Qualifications
Provides clinical information to all payers as required by contract, rules or regulations.
Monitors utilization and ensures appropriate reimbursement for services provided. Works cooperatively with the health care team to determine appropriate level of services moving patients efficiently through the continuum of care while maintaining high quality of services.
Required Education: Registered nurse or licensed practical nurse with acute care clinical nursing experience.
Preferred experience in applying level of care criteria and payer guidelines to support admission and continued stay approval by payer. Ability to read, analyze, and interpret written materials, financial reports and legal documents. Ability to communicate effectively, verbally and in writing with peers, customers, staff, physicians and other agencies. Advanced knowledge of computers; must be able to navigate multiple computer and data entry systems.
Preferred Education: Associate's Degree
Required License: Must have and maintain current licensure as a registered nurse or licensed practical nurse with the North Carolina Board of Nursing or one of the compact states as defined by the North Carolina Board of Nursing.
Preferred License: None
Required Experience: Three to five years of clinical nursing in an acute care hospital setting.
Preferred Experience: Five to eight years of recent clinical nursing in an acute care hospital setting.
Mission Health System, Inc