RN - Precert Nurse Care Manager - FHHS
Job ID: 24191
Reports to the Director of Medical Management/Precertification of FHHS. Provides supervisory oversight of the Precertification Department, training and orientation of the Precertification Intake Coordinators, work flows and protocols of the department. Provides supervisory input relative the Precert staff evaluation and performance. Evaluates and current processes to determine appropriate recommendation and updates management on work-related issues such as risk management issues, cost containment concerns, interdepartmental and intradepartmental issues. Oversight of the Intake Coordinator’s determination of requested medical services to ensure it meets designated medical criteria and coverage under the health plan benefits. Responsible for ensuring efficient service metrics and compliance with regulatory requirements.Attends pertinent seminars, workshops and professional meetings to maintain up-to-date knowledge base as it relates to the inpatient/precertification process. Actively participates in outstanding customer service and accept responsibility in maintaining relationships that are equally respectful to all.
Knowledge and Skills Required:
Comprehensive knowledge and understanding of managed care, precertification, and reimbursement methodology. Ability to work effectively with physicians and other health care professionals. Excellent organizational skills, written and verbal communication skills in English. Accurate and efficient typing, grammar, and writing skills. Computer knowledg/skills to include spread sheets, word processing, email, and presentation software preferred. Must maintain confidentiality of employee and patient information. Ability to work with people of various backgrounds. Possess personal qualities that make it possible to maintain good interpersonal relationships with a large department staff, medical staff, administration, sales representatives, clients, and members.
Education and Experience Required:
Graduate of school of nursing. Two (2) years minimum of precertification and supervisory experience required. Registered Nurse with Bachelor in Science of Nursing (BSN) or advanced degree preferred. Experience with medical coding (ICD-9 and CPT), and application of clinical guidelines is required.
Licensure, Certification, or Registration Required:
Current registration with Florida State Board of Nursing. Nursing licensure in good standing with the state of Florida.
