Prior clinical experience in an acute care, skilled or rehabilitation clinical setting. Intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook. All technical requirements listed by the company.
Coordinate care and reassess member's needs. Ensure that members transition to a setting with adequate caregiving and functional support. Conduct face-to-face visits of all members while in the hospital. Position Requirements Include:
Provide a complete continuum of quality care through close communication with members. Support members with condition education, medication reviews and connections to resources. Qualifications Include: 25-50% travel. Current, unrestricted RN license. Access to reliable transportation.
Supporting health plan operations. Required Skills: Three years of utilization management or discharge planning. Graduate of an accredited school of nursing. Active unrestricted RN license in the State of Arizona. Clinical experience in medical/surgical or specialty care.
Supporting clinical services such as the appeals program. Skills and Requirements Include: Bachelors: Nursing (Required) License and Certifications - Required. RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt. Language(s)English.
Performing weekly, monthly and/or quarterly quality reviews as directed to support each function. Prioritizing audits that support the business objectives. Position Requirements Include: Travel 25% of the time. Minimum of 3 years of clinical practice experience.
Active unrestricted Resident OR Non-Resident RN license in state of CA. Minimum of 1 year recent health plan case/care management experience. Knowledge of health and/or patient education and behavioral change techniques. Strong computer technical skills.
Construct and document a succinct and fact-based clinical case to support appeal. Assist Law Department with any medical necessity reviews as capacity allows. Applicants must meet the following qualifications:
Core Responsibilities Include: Engaging members to support the appropriate level of care. Working closely with providers to assure members are being provided the highest quality of care. Reviewing proposed medical care cases for medical necessity against established CMS Coverage Guidelines.
Identify and refer for ancillary and supportive covered benefits. Qualifications for this position include: Graduate of an accredited school of Nursing. Three years of oncology nursing experience. Strong communication skills, problem resolution skills and facilitation skills.