- Reviews all assigned cases, ensures documentation in the medical record supports plan of care and justifies admission and continued stay.
- Coordinates with finance for insurance verification.
- Completes admission and continued stay reviews using MCG/IQ criteria, leading to optimal reimbursement.
- Discusses cases with primary physician when medical record does not meet medical necessity to obtain additional supporting documentation.
- Reviews and discusses level of care with primary physician to ensure accuracy of the level of care determination with appropriate billing indicators (ex: Observation, ALOC).
- Responds to requests for clinical information in a timely manner (within 24 hours or next business day).
- Acts upon concurrent denials, facilitates MD to MD review.
- Closes cases appropriately. Provides discharge date/discharge review to managed care company.
- Obtain authorization for post-acute care such as SAR/SNF, LTACH, LTC, partial hospitalization program, transportation or inpatient hospice, transportation, etc.
- Performs all other duties as assigned by Supervisor or designee.
Requirements:
1. Valid New York State license and current registration to practice as a Registered Professional Nurse issued by the New York State Education Department (NYSED); and
2. A Baccalaureate degree in Nursing or related health field from an accredited college or university; and
3. Holds, or obtains through facility orientation, a valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA); and
4. Two (2) years of experience as a Registered Professional Nurse in Psychiatry
Job Type: Full-time
Pay: Up to $109,739.00 per year
Benefits:
- Dental insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Schedule:
- 12 hour shift
- 8 hour shift
- Day shift
- Monday to Friday
- Weekends as needed
Application Question(s):
- Do you possess a valid New York State Nursing License?
Ability to Relocate:
- New York, NY 10016: Relocate before starting work (Required)
Work Location: In person