Utilization Review Nurse

Utilization Review Nurse

Location: Philippines

About Us:

HBiz is a leading Revenue Cycle Management (RCM) company dedicated to helping healthcare providers optimize their financial performance. We specialize in delivering innovative solutions that streamline revenue cycle operations and enhance overall revenue generation for healthcare organizations. Our mission is to empower healthcare providers with the tools and expertise needed to maximize revenue, reduce operational costs, and improve patient care.

Job Summary:

We are seeking a highly motivated and experienced Clinical Case Management Nurse to join our team. The Clinical Case Management Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective case management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

Clinical Assessment: Conduct comprehensive clinical assessments to determine the patient's medical condition, healthcare needs, and treatment options.

Patient Advocacy: Serve as an advocate for patients by ensuring they receive appropriate care, coordinating with healthcare providers, and assisting in the resolution of healthcare-related issues.

Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.

Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.

Utilization Review: Evaluate the necessity and appropriateness of healthcare services and assist in the management of length of stay, ensuring that healthcare resources are used efficiently.

Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.

Patient Education: Educate patients and their families about healthcare options, treatment plans, and financial responsibilities, helping to promote informed decision-making.

Quality Assurance: Ensure the quality of care provided meets or exceeds established standards and that clinical documentation accurately reflects the patient's condition and care provided.

Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.

Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards.

Qualifications:

Registered Nurse (RN) licensure in the state of practice.

Bachelor of Science in Nursing (BSN) preferred.

Case Management Certification (e.g., CCM) is a plus.

Minimum of 2 years of clinical nursing experience, preferably in a hospital or acute care setting.

Strong understanding of revenue cycle management and healthcare reimbursement.

Proficiency in medical coding and clinical documentation improvement.

Excellent communication, interpersonal, and teamwork skills.

Ability to work independently and make sound clinical and financial decisions.

Strong analytical and problem-solving skills.

Proficient in using healthcare information systems and technology.

Commitment to maintaining patient confidentiality and ethical standards.

Benefits:

Competitive salary

Comprehensive healthcare benefits

Professional development and training opportunities

Collaborative and supportive work environment

Opportunities for advancement within the company

Work-life balance programs

If you are a skilled Clinical Case Management Nurse who is passionate about enhancing patient care and optimizing revenue cycle processes, we encourage you to apply for this exciting opportunity with [Company Name]. Join us in making a positive impact on the healthcare industry and helping healthcare providers thrive financially while providing top-notch patient care.