· Hospital Overview:
Beaumont Hospital, Grosse Pointe is a 250-bed community hospital located in the heart of the Grosse Pointe community. The hospital has won the Governor's award multiple years in multiple areas. The Care Management Department consists of approximately thirty Case Management professionals and four Social Workers all reporting directly to the Director of Care Management for Beaumont Grosse Pointe.
The Clinical Nurse Reviewer within the Resource Center works collaboratively with Care Management and as a liaison to the payors to assure that all clinical information is accurate and reaches the payor in a timely manner to avoid any financial penalty.
1. Effectively communicates clinical information to payors to assure proper authorization and payment
2. Acts as a liaison between CM staff and the payors
3. Provides prompt communication not only to payors but also back to Care Manager regarding the status of a patient
4. Notes all discharges as well as responds to work queues as appropriate
5. Maintains accurate and timely communication in EPIC
6. Remains current on payor guidelines and process.
- Associate Degree in Nursing, required
- Bachelor Degree in Nursing, preferred
- Current RN license in the State of Michigan, required
- Clinical experience required, prior Care Management experience strongly preferred
- Working knowledge of InterQual guidelines
- Understanding of third party payor rules and regulations
- Working understanding of HIPPA Guidelines
- Must be flexible and keep updated with constant insurance changes
- Must be able to assimilate knowledge quickly and change accordingly