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RN Recovery Nurse Specialist - Revenue Cycle Solutions Team - Full Time - Days - Work from Home - New Orleans Louisiana
Company: Ochsner Clinic Foundation Location: New Orleans, Louisiana
Posted On: 05/04/2024
We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, andinnovate.Webelieve that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today! This job applies clinical expertise as well as knowledge of utilization and discharge planning criteria to review medical information of prior hospitalized patients that are being reviewed via the regulatory audit process. Identifies issues and problems such as inappropriate admissions and non-acute hospital days which may adversely impact quality patient care, appropriate utilization of hospital resources, or optimal financial reimbursement to Ochsner Health System (OHS). Functions as a liaison with the department Vice President/Manager of Regulatory Audits and ensures compliance with regulations and alternative level of care options affecting OHS revenue as it relates to all medical necessity audits. Education Required -Registered Nurse Diploma Preferred - Associate's or Bachelor's degree in Nursing Work Experience Required -3 years Hospital based experience in the delivery of patient care as an RN. Experience in Case Management, Utilization Review and/or Discharge Planning .either in the Acute Care environment or Managed Care environment. Experience responding to change positively and work calmly as well as efficiently in high pressure situations. Experience functioning independently and working well within a team setting. Preferred - Experience in Appeal/Denial Management Certifications Required - Current State of Louisiana Registered Nurse (RN) License Preferred -Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization Management or Health Care Management (CPUR, CPUM, and CPHM) Knowledge Skills and Abilities (KSAs) - Must have computer skills and dexterity required for data entry and retrieval of patient information.
- Must be proficient with Windows-style applications, various software packages specific to role and keyboard.
- Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process
- Strong financial skills Job Duties
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