Job Summary
Description:
We are seeking an experienced Registered Nurse (RN) to participate in a special program of care planning and coordination of services for health plan members. The Care Coordinator is skillful in transition of care throughout the health delivery system and acts as advocate as well as liaison between providers, and members who often are more high risk and high cost. Strong utilization review and case management background in managed care is essential. Military case management experience is preferred. This challenging position requires strong critical thinking skills as well as assessment, coordination, planning and evaluating of multiple environments.
The RN will reside in the Pacific Time Zone and telecommute from work Monday thru Friday during normal business hours. This is a full time position that is temporary for a period of two to four months with the intent to direct hire.
Job Duties include:
Clinical review of services requiring authorization for appropriateness based on InterQual criteria
Facilitates the clinical progression of care and collaborates with health plan member, family and members of the military health care team utilization community resources to provide the best quality of care
Manages and prioritizes care coordination activities applies knowledge of complex care planning
Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services
Processes all prior authorizations to completion utilizing appropriate review criteria
Identifies process improvement opportunities
Ability to communicate with top level decision-makers to facilitate a safe discharge plan and assure progression of care
Qualification:
Graduate of an accredited program of nursing
Minimum of five years utilization review/case management or acute care coordination experience in a Managed Care setting
Exceptional complex care coordination experience required!
Previous experience working with military a plus!
Use of InterQual criteria required
Strong computer skills; proficient in Windows, Excel and prior use of a laptop
Active unrestricted RN license in CA
The Benefits of Working with PSN*
RN Nurse Recruiters
- we provide a Nurse to Nurse connection!
27 years of experience in this field!
Direct relationship with hiring managers!
Online timesheet entry
Direct Deposit
Weekly paycheck
Health, Vision & Dental insurance*
Life/AD&D, Basic & Supplemental*
Short-term disability insurance*
Employee Assistance Program (EAP)
*Upon meeting Company & plan eligibility requirements
If temporary job becomes a direct hire by the client, the following are the Client's benefits:
Client Company Benefits*
Health, Vision & Dental insurance
Flexible spending accounts
Short- and long-term disability insurance
Basic Life insurance
Supplemental Life/AD&D
401(k) retirement plan
Paid-Time-Off to include: Vacation, Personal and Sick time & Company Holidays
Employee Assistance Program (EAP)
Tuition Reimbursement/Educational Assistance
*Upon meeting company & plan eligibility requirements
Licensure
Active unrestricted RN license in CA
SH: 5/2