Employment Type:

Shift:

Description:

The Care Compass department oversees hospital wide utilization review, clinical review, discharge planning, and patient progression.

Within the Care Compass department and in conjunction with the department leadership team, the RN Coordinator will oversee payer relations, hospital accounts and billing processes as it relates to UR, clinical review, denials management, and UR processes. Responsibilities include but are not limited to:

• Ensuring appropriate hospital billing functions are being applied to all accounts.
• Monitoring incoming and outgoing payer communication, including the sending of medical records to payers for authorization purposes, requests for more information, denials, and approvals.
• Participating in Revenue Cycle functions including work queue and account management, monitoring metrics, and attendance at meetings.
• Acting as a point person and liaison between the Care Compass department and other departments including Revenue Integrity and Hospital Billing, in addition to external agencies.

Organization Highlights:

• Recognized Leader: First Magnet Designated Hospital in Syracuse, highlighting our professional nursing staff.
• Shared Governance: Unit practice counsel and open-door guiding principle gives all our nurses a voice.
• Advancement: Strong orientation, leadership development programs and generous tuition allowance.
• Work/Life: Patterned, predictive scheduling options to balance your work/life and school calendars.

Responsibilities:

• Educate team members in competencies associated with utilization review, hospital billing, and revenue cycle.

• Maintain the prescribed workload including work queue management, process oversight and committee responsibilities.
• Collaborate with leadership to implement policy and process development as needed.
• Collaborate with leadership to achieve unit and organizational quality improvement and outcome-based initiatives.
• Participate in interdisciplinary meetings regarding UR and denials management, including retroactive chart reviews, data collection, and process development.

Education, Training, Experience, Certification and Licensure:

• Bachelor’s Degree in Nursing preferred with three to five years progressive experience in the field, including knowledge of utilization management and payer communication. Ideally the candidate will have strong clinical skills, leadership qualities and be actively working toward an advanced degree.
• Graduate of an accredited School of Nursing and current licensure as a Registered Nurse in New York State.
• Participates in orientation and continuing education and updates and maintains knowledge and skills related to specific areas of expertise. Completes population specific competency annually on populations served as identified in scope of care and services.
• Maintain BLS/CPR certification. Maintain other certifications appropriate to field.
• Clinical Ladder participation preferred.

Career Path:

• Career advancement to senior leadership roles such as Manager, Director or Administrative roles.

Mission Statement:

• We, St Joseph's Health and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Vision:

• To be world-renowned for passionate patient care and outstanding clinical outcomes.

Core Values:

• In the spirit of good Stewardship, we heal by practicing Justice in fostering right relationships to promote common good, Reverence in honoring the dignity of every person, Excellence in expecting the best of ourselves and others; Integrity in being faithful to who we say we are.

Work Environment and Hazards:

• Office setting
• Work from home

Physical Demands:

• None

Work Contact Group:

• All services, clinical staff, non-clinical staff, and various regulatory and professional agencies.

Supervised By:

• Unit Manager and Director.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.