Job Description:

Data Coordinator

40 weekly hours, full time, dayshift

Job Summary:

As a team member of the Cooperative Care Program, completes utilization review on all patients, gathers quality improvement data as requested by medical staff, patient care committees and hospital departments/staff, and communicates complex quality/patient issues to the Care Coordinator.

Principal Duties and Responsibilities:

The following is a summary of the major functions of this individual's job. He or she may perform other duties, both major and minor, which are not mentioned below, and specific functions may change from time to time.

1. Completes utilization review for patients requiring review by a third party payer and/or Medicare in the following circumstances:

• Admission review
• Continued stay review
• Retrospective review as requested
• Refers for secondary review per procedure (EHR).

2. Communicates insurance certification with insurance verification staff, business office staff, and Care Coordinator.

3. Identifies the following types of utilization cases to prevent/decrease occurrences:

• Care in inappropriate setting
• Non-approved admission
• Non-approved days
• Days awaiting placement
• Delay in providing services
• Patient stability for discharge

4. Promotes quality improvement by identifying and intervening in

• Quality of care issues
• Abnormal lab, etc., not addressed
• Inappropriate antibiotic/medication use
• Inappropriate blood/blood product usage
• Deficient clinical documentation
• Operative/Invasive procedures
• Risk Management and Infection Control Issues

5. In collaboration with Care Coordinator, refers review data to physician advisor and refers cases to Care Coordinator for negotiation with third party payers for services not covered in contract.

6. Collaborates with team members to achieve desired patient outcomes, including denial decisions from insurance companies.

7. Consistently and accurately documents all insurance certification data.

8. Establishes and maintains accurate tracking of insurance certification reviews.

9. Promotes positive customer relations through tactful contact with physicians, patients, visitors, outside review organizations and co-workers.

10. Discusses cases which may require provider denial letters with Care Coordinator, supplying information necessary to determine case status.

11. Develops and maintains good working relationships with Cooperative Care Team, hospital and medical staff, and personnel from community health, welfare and social agencies.

Minimum Education, Training and Experience Required:

LPN with 5 years experience in medical-surgical nursing.

Currently licensed in the state of Kentucky.

OR

RHIA OR RHIT with 5 years experience in utilization review and/or quality resources, or other related experience.

If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!

Employees will be expected to comply with Baptist Health’s infectious disease and vaccination policies, which include but may not be limited to compliance with BHS’ mandatory vaccination policies for influenza and COVID unless reasonable accommodations are needed under applicable law

Baptist Health is an Equal Employment Opportunity employer.