Posting Description

We believe a career is more than just a career — it's a calling. Our teammates' "True North" is what calls them to health care; it’s their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love.

Essential FunctionsList major areas of responsibility and briefly what the person does in each area. Coordinates:

• Consults with physician services
• Utilizes clinical diagnostics, physician documentation and non-physician clinical guidelines to facilitate status determination of inpatient, outpatient or outpatient observation.
• Coordinates final status with admitting and attending physicians
• Performs initial and concurrent clinical reviews as indicated by payer and patient clinical needs
• Inpatient and/or outpatient notification and precertification of services to payers
• Facilitates peer to peer, written reconsiderations or appeals throughout all denial cycle as appropriate
• Facilitates appropriate observation utilization
• Consults with patient financial services
  
  

Educations:

• Provides education and literature to physician services regarding IPPS and OPPS
• Educates physicians and other care team member on level of care criteria and other third party payer requirements
  
  

Reporting/Recordkeeping:

• Updates patient’s medical records as required
• Shares medical necessity documentation with payers to facilitate reimbursement
  
  

Regulation:

• Adheres to NMHS/NMMC Policies/Procedures/Guidelines
• Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues
  
  

Know How

Job Knowledge

Specify required education, licensure/certification, prior experience, skill behavior, equipment operation, type and duration of on-the-job training, patient population to be served, etc.

• Associates Degree in Nursing, required; Bachelor’s Degree preferred
• Licensed as a Registered Nurse by the Mississippi Board of Nursing; required
• Minimum of 5 years clinical and/or healthcare experience; required
• Excellent organizational and communication (written and verbal) skills; required
• Knowledge of various payer sources, federal/state laws/regulations, and cost containment; required
• Certified as an Accredited Case Manager (ACM); desirable
• Excellent interpersonal skills; required
• Demonstrates ability to care for a patient population from pediatric to geriatric; required