Founded in 1941, Dignity Health - Dominican Hospital is a 188-bed, acute care, nonprofit hospital located in Santa Cruz, California. Serving over 80,000 patients annually, the hospital offers a full complement of services including heart care, orthopedics, and a Family Birthing Center. Additionally, Dominican Hospital has been recognized as an LGBTQ+ Healthcare Equality High Performer by the Human Rights Campaign Foundation. It is a Joint Commission-certified Primary Stroke Center, and has been awarded the AMA/ASA’s Get the Guidelines - Stroke Gold Plus Quality Achievement, recognizing the hospital’s commitment to providing the best stroke care.
Responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.
Requirements:
Minimum two (2) years of acute hospital clinical experience
Licensure and Certifications:
Preferred:
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