staff - Supervisor Registered Nurse (RN) - Resource

Company: Baylor Scott & White Health
Location: Mesquite
Posted on: September 20, 2023

Job Description:

Baylor Scott & White Health is seeking a Registered Nurse (RN) Resource Supervisor for a nursing job in Dallas, Texas.Job Description & Requirements

• Specialty: Resource
• Discipline: RN
• Start Date: ASAP
• Duration: Ongoing
• 36 hours per week
• Shift: 12 hours
• Employment Type: Staff
  JOB SUMMARY
  The Supervisor, Denial Resource Center provides direction regarding cases submitted to the Denial Resource Center (DRC) for clinical appeal. The Supervisor provides guidance to appeal writers and administrative assistants on daily workflow and ensures appropriate distribution of workload and cases.
  ESSENTIAL FUNCTIONS OF THE ROLE
  
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  • Supervises Denial Resource Center (DRC) RNs and Administrative Assistants through the monitoring of staff workload, developing staff assignments, and reviewing of productivity. Handles escalations from DRC RNs.
    
  • Conducts quality reviews, advises with peer-to-peer appeals and denial research.
    
  • Studies deadline report and worklists and assigns high priority, special cause accounts. Evaluates incoming cases for readiness for appeal and appropriate expertise assigned for appeal.
    
  • Recommends and implements quality improvement initiatives
    
  • Helps orientation of new staff and ongoing training
    
  • Reviews cases for appropriateness for referral for external appeal such as ALJ, THHSC, VA complaints. Writes clinical appeals, as needed.
    
  • Serves as a resource for staff related to complex accounts.
    
  • Interfaces with Collectors, Administrative Assistants and Appeal Writers to assess effectiveness of work processes and acts upon opportunities for improvement with account handoffs and communication regarding cases.
    
  • Serves as resource for IT and training on BSWH systems used in the DRC (e.g. Midas, AEOS, EPIC, Allscripts, PatCom, Nuance, Microsoft Office Suite, etc.).
    
  • Prepares reports as assigned for use within the department and external customers. This includes but is not limited to routine reports for verifying status of accounts using MIDAS, TRAC, AEOS.
    
    KEY SUCCESS FACTORS
    
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    • Knows commercial and government regulations for reimbursement including, but not limited to: InterQual, RAC/MAC, Clinical Policy Bulletins, national and local coverage determinations, CMS admission status requirements, TJC conditions of participation, CMS appeals process, including Administrative Law Judge.
      
    • Knowledge and expertise of nursing and patient care standards and procedures.
      
    • Knowledge of laws, rules and regulations; standards and guidelines of certifying and accrediting bodies; hospital and department/unit standards, protocols, policies and procedures governing the provision of nursing care applicable to the area of assignment.
      
    • Knowledge of medical terminology; methods and practices of health promotion, risk reduction, illness and disease prevention and management; medications and drugs, common dosages, their physical and physiological effects, and possible adverse reactions.
      
    • Knowledge of medical and professional nursing ethics and patient privacy rights.
      
    • Must be able to communicate thoughts clearly, both verbally and in writing.
      
    • Social skills to interact with a wide-range of constituencies.
      
    • Must have critical thinking and problem-solving skills.
      
    • Ability to observe changes in the medical condition of patients and effectively communicate these changes to other nursing staff members and physicians/providers.
      
    • Ability to provide age-specific, quality, patient-centered care to all patients through the nursing process and standards of nursing practice with care and respect for the diversity of human experience and to develop, evaluate, implement and, as necessary, modify a patient care plan to meet the needs of separate patients.
      
    • Ability to make tactical steps around the allocation and direction of the work of supervised employees using established guidelines, policies and/or procedures.
      
    • Ability to make effective hiring and termination recommendations.
      
    • Ability to train and evaluate performance of supervised staff.
      
    • General computer skills, including but not limited to: Microsoft Office, information security, scheduling and payroll systems, electronic medical documentation, and email.
      
    • ACM or CCM license preferred.
      
      BENEFITS
      Our competitive benefits package includes the following
      
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      • Immediate eligibility for health and welfare benefits
        
      • 401(k) savings plan with dollar-for-dollar match up to 5%
        
      • Tuition Reimbursement
        
      • PTO accrual beginning Day 1
        
        Note: Benefits may vary based upon position type and/or levelQUALIFICATIONS- EDUCATION - Associate's- MAJOR - Nursing- EXPERIENCE - 3 Years of Experience- CERTIFICATION/LICENSE/REGISTRATION - --------------Registered Nurse (RN)
        Candidate must be able to:--
        
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        • Laptop is picked up from the Admin Building in Downtown Dallas
          
        • Non-working computers will need to be brought in the Admin Building or other Baylor Locations (with prearranged approval) for repair/swap out
          
        • In the event of personal outage disabling their PC working onsite at the Admin Build or a Baylor Hospital Location is possible until resolved
          
        • A Saturday 4 hour Onsite Meeting is required twice a year.--
          
        • Supervisor may need to go onsite to the Admin Building or other Baylor Location periodically as needed to transition new hires, facilitate corrective action plans, or attend meetings etc
          
          --Recruiter: Alesandra DunnBaylor Scott and White Job ID #23014139. Posted job title: Supervisor Denial Resource Center RN (Hybrid)About Baylor Scott & White HealthAs the largest not-for-profit health system in the state of Texas, Baylor Scott & White promotes the health and well-being of every individual, family and community it serves. It is committed to making quality care more accessible, convenient and affordable through its integrated delivery network, which includes the Baylor Scott & White Health Plan, Baylor Scott & White Research Institute, the Baylor Scott & White Quality Alliance and its leading digital health platform - MyBSWHealth. Through 51 hospitals and more than 1,100 access points, including flagship academic medical centers in Dallas, Fort Worth and Temple, the system offers the full continuum of care, from primary to award-winning specialty care. Founded as a Christian ministry of healing more than a century ago, Baylor Scott & White today serves more than three million Texans.Benefits
          • Holiday Pay
          • Continuing Education
          • 401k retirement plan
          • Wellness and fitness programs
          • Employee assistance programs
          • Medical benefits
          • Dental benefits
          • Vision benefits
          • Benefits start day 1
          • Life insurance
          • Discount program

Keywords: Baylor Scott & White Health, Mesquite , staff - Supervisor Registered Nurse (RN) - Resource, Healthcare , Mesquite, Texas