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Department: Care Management - GP
Schedule: Full Time - Regular
Shift: Days
Hours: 8:00 am - 4:30 pm (Monday-Friday)
Job Details:
  • ยท      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.

    Job Overview:

    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.

    Essential Responsibilities:
    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.

    Education/Experience/Knowledge Qualifications:
    - Associate Degree in Nursing,
    Bachelor Degree in Nursing, preferred 
    - Current RN license in the State of Michigan,
    - 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


HR use Only:  

William Beaumont Hospital is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, or status as a qualified individual with a disability.

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