Job ID: 443742
Business Unit: Corporate Office
Location: Mpls-Allina Commons
Full/Part Time: Full-Time
Standard Hours: 40.00
Union Position? N
Allina Health is a not-for-profit system of hospitals, clinics and other health care services with more than 23,500 employees, 5,000 physicians and 2,500 volunteers dedicated to meeting the lifelong health care needs of patients and communities throughout Minnesota and western Wisconsin. Allina is a vibrant, growing organization with opportunities to suit your professional skills and a diverse work environment to match your specific interests. We believe employees are our greatest asset and are dedicated to helping you develop and maximize your professional skills.
Allina Commons is the Minneapolis-based headquarters of Allina Health, a not-for-profit health care organization serving patients and communities. Approximately 1,600 corporate and administrative service employees work at offices within Midtown Exchange, site of the historic Sears retail complex at Chicago Avenue and E. Lake Street. This community landmark, adjacent to the campus of Allina's Abbott Northwestern Hospital, is the second largest building in Minnesota and includes offices, an internationally themed public market and residential units.
- Assess currently admitted inpatient, observation and outpatient admissions according to admission criteria for all different hospital disciplines (Mental Health, Substance Abuse, Acute Care, Rehab, Observation, etc.)
- Assess clinical data from medical records to assure appropriateness of patient's admission
- Ensure proper authorization requirements are met with each admission
- Monitor continued stay, identify potential issues and communicate the results and opportunities to nurses, physicians, finance, case managers and payers concurrently
- Provide consultation to medical and nursing staff, health information management, payers and patients on potential issues with reimbursement of hospitalization
- Evaluate potential denials or payment issues and initiate communication with physician and/or clinician to assure proper documentation for selected admission status
- Assure proper physician order is in the record for the correct patient status. If the order is incorrect, facilitate discussion with the appropriate physician.
- Facilitate physician peer to peer requests when the treatment request does not meet necessity per guidelines, when guidelines are not available, or per customer account instructions. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the attending provider.
- RN or LADC licensure required
- Bachelors Degree preferred
- 3-5 years of Acute Care, Behavioral Health, Substance Abuse experience preferred
- Understanding/knowledge of Interqual and Milliman and Roberson admission criteria preferred
- Knowledge of Medicare, Medicaid and other commercial payer admission requirements
- Knowledge of managed care concepts including Utilization Management, Prior Authorizations and Denial and Appeal process
- Medical Terminology
- MN RN or LADC licensure
- Strong computer skills
- Excellent clinical assessment and competence
- Excellent communication and organizational skills
- Demonstrated critical thinking and problem solving skills
- Organizational/time management skills/prioritization
- Multitasking and team work skills
- Excellent written and verbal skills
Pay,Benefits, & Work Schedule
- Full time position (40 hours/week)
- Day/Evening Shift
- Occasional weekends
Minneapolis boasts being both cosmopolitan yet small enough that you can find a place to call home whether on a lake, golf course, or in an adjoining suburb. With the fast pace of activity there are professional sports, theater, or enough parks for a quiet walk. The area has numerous schools and colleges, both public or private, and enough teams for all weekend athletes to join.
- Located in Minneapolis
- Population = 380,000
- Service Area = 2,882,245
Community Resource Links:
If you are interested in becoming part of our award winning team of professionals, please apply online today. Allina Health is committed to providing Equal Employment Opportunities to all employees and applicants. EEO / AA