+ JOB REQUIREMENTS + Education + Registered Nurse or Licensed Practical Nurse with current and unrestricted license in the state of Arkansas. + Experience + Minimum of 5 years experience in a hospital IP/OP setting. Documented experience in practice area. + Physical + This is a safety sensitive position. Please see the St. Bernards Substance Abuse Policy for further information. + Normal hospital environment. Occasional exposure to fumes, odors, biological and electrical hazards. Normal/corrected eyesight with close eye work. Hearing of normal and soft tones. Uses computer, telephone, copier, fax, scanner and adding machine. Lifting up to 50 lbs, carrying up to 20 lbs, pushing and pulling up to 100 lbs. Will be extended of sitting and or considerable walking throughout clinical areas and departments. + JOB SUMMARY + This position is responsible for submitting clinicals to payers to prove need for hospital admission and continued care throughout the admission. Assists with and ensures the collection, analysis and reporting of complex clinical data to be used to support the utilization of clinical resources. This data will ensure appropriate reimbursement for medical services, satisfy requirements of accrediting organizations and support clinical improvement activities. Ensures compliance with guidelines, institutional policies and procedures, and other information to determine appropriate transfers and admissions into Medical Center and/or Behavioral Health. Facilitates care during hospitalization of the assigned caseload by coordinating and monitoring resources to achieve optimal clinical and financial outcomes, utilization and discharge. Works with UR Nurses, Case Managers and Providers to ensure appropriate level of care. Responsible for any payer notifications such as peer-to-peer reviews and education to medical staff and hospital staff of level of care determination. This position will be cross-trained in the department and serves as a backup for assistance with Skilled Nursing Facility Authorizations. Responsible for meeting department goals. This position is required to utilize independent judgment.