Reviewing utilization information concerning patient care. Documenting all interactions, guidance and interventions in applications. Contacting referral sources to advise them of referral status. Required Skills: Registered Nurse with licensure in the state(s) of practice.
Providing services to individuals who otherwise may not have access to care. Completing any other assigned tasks. Position Requirements Include: Board Certified Psychiatric Mental Health Nurse Practitioner. Any required technology. Any applicable experience.
Fostering dialogue between patient and healthcare provider. Coordinating the connection between patients and program approved. Applicants must meet the following qualifications: Travel up to 20% Valid driver's license required. 5 yrs. clinical experience in healthcare.
Identifying potential new standards in care that may be then added to the evidenced based library. Requesting Peer to Peer when appropriate based on a review of the case. Reviewing of customized treatment plans and clinical trials. Must meet the following requirements for consideration:
Interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Skills and Requirements Include: Active RN license without restrictions. Previous experience in utilization management.
Gather clinical information to assess and expedite care needs. Qualifications Include: Proficient with Microsoft Word to create, edit, save and send documents. Current, unrestricted RN license in the state of residence. 3 years recent hands on clinical experience.
Have an ASN/BSN. Willing to apply for any state licensure the organization requests. 1 year of experience in a Managed care organization (MCO) or Third party administrator (TPA) Become knowledgeable of URAC requirements for CM accreditation. Have reliable high-speed internet service at home.
A healthcare provider and insurer is searching for a person to fill their position for a Remote Clinical Prevention Nursing Specialist. Core Responsibilities of this position include: Preparing high quality professional written consultation and service documentation.
Perform care management within the scope of licensure for members. Ensure member access to services appropriate to their health needs. Position Requirements Include: Must live within 60 miles or 1 hour of local office. 3 years of clinical RN experience. BA/BS in a health related field.
3 years diversified nursing experience providing direct care in an inpatient or outpatient setting. 1 or more years experience performing medical records review. 1 or more years experience in healthcare claims. Experience with utilization management systems or clinical decision making tools.