Utilization Review Coordinator
Tampa , FL
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Job Description
At St. Jude Children's Research Hospital no one pays for treatment beyond what is covered by insurance and those without insurance are never asked to pay. The nurses in the Utilization Review department ascertain insurance coverage and by providing clinical information they attempt to obtain reimbursement from third party payors when benefits are available. This assists St. Jude Children's Research Hospital to continue its mission to care for children with catastrophic diseases and to continue research to find cures and improve treatments for children worldwide.
Your role as a Utilization Review Coordinator will entail:
• Assists in maintaining the Utilization Review program for the Patient Business Services Department
• Obtains authorizations/certifications from insurance companies/third party payors for services provided at St. Jude.
• Assists in the development of Process Improvement tools in the Utilization Review Department and Patient Business Services.
• Graduate of an accredited RN program
• Bachelors' Degree in Nursing or a related area preferred
• Three (3) years related medical experience
• Six (6) months experience in a hospital environment required
• Utilization review experience preferred
• Experience with InterQual guidelines and Cerner systems preferred
• (LC:RN-TN) Must possess a current Tennessee State Board of Nursing license if primary residence is Tennessee or a Nurse Licensure non-Compact state.(LC:RN-MISS, RN_ARK or RN-KY) Must possess a current State Board of Nursing license in the state of primary residence if the state is a Nurse Licensure Compact state
• Certified Case Manager preferred
No Search Firms: St. Jude Children's Research Hospital does not accept unsolicited assistance from search firms for employment opportunities. Please do not call or email. All resumes submitted by search firms to any employee or other representative at St. Jude via email, the internet or in any form and/or method without a valid written search agreement in place and approved by HR will result in no fee being paid in the event the candidate is hired by St. Jude.
St. Jude Children's Research Hospital is an Equal Opportunity Employer. St. Jude does not discriminate on the basis of race, national origin, sex, genetic information, sexual orientation, gender identity, transgender status, age, religion, disability, veteran's status or disabled veteran's status with respect to employment opportunities. All qualified applicants will be considered for employment. St. Jude engages in affirmative action to increase employment opportunities for minorities, women, veterans and individuals with disabilities.
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Job Summary
Company
St. Jude Children's Research Hospital
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
3 years