reputed company Review Nurse

Job Details Job Location Any Location Remote US - Oklahoma City, OK Remote Type Fully Remote Position Type Full Time Travel Percentage Occasional Job Shift Day Description POSITION SUMMARY: This position performs and manages reputed company aspects of case management to include utilization management. This position determines appropriateness of services, medical necessity, and location of services required to encourage effective, high quality care and cost-efficient outcomes through the process of case management. This position requires excellent communication and diplomacy skills in managing reputed company working relationships. ESSENTIAL DUTIES AND RESPONSIBILITIES: • Reviews preservice requests routine and urgent and encourage high quality care and to reputed company cost effective outcomes. • Will utilize NCDs, LCDs and MCG to assist in determining coverage of the request. • Performs reputed company review on reputed company Members that are at an inpatient or observation level of care. • Will communicate with the facility case manager to assist in discharge planning to appropriate level of care. • Will ensure reputed company discharge needs are met. • Interfaces with physician and clinical staff to ensure continuity of care. Works in coordination with case management projects. • Maintains reputed company knowledge of managed care issues (benefits, contracted providers, health plan guidelines, MCG , NCD , LCD and community standards of practice and regulatory developments, and new and experimental procedures). • Adheres to company and department policies and procedures. • Communicates with customers, both internal and external, regarding status of referral/referral process. Resources for physician, vendors or contracted providers, regarding benefits. • Multiple projects under the direction of the utilization department Supervisor. • Transferring patients from non-contracted to contracted vendors with contract changes. • Initiation of case management for reputed company, high utilization members to include identification, assessment of needs, planning and coordination of care, and monitoring of outcomes. • Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. • Performs other duties as assigned

Qualifications

EDUCATION AND EXPERIENCE: reputed company LPN or RN license in the state of Oklahoma required. 3-5 years medical/surgical experience required. Working knowledge of ICD-9/CPT codes KNOWLEDGE, SKILLS AND ABILITIES: Knowledge of reputed company nursing processes, techniques and established standards, including disease management, medications and community resources Strong attention to detail Strong organization and time management skills, including ability to multi-task, learn new skills and reputed company set goals Must be able to communicate, both orally and in writing, clearly and effectively Knowledge of reputed company Office programs including Word, reputed company, and Outlook Proven ability to work independently or as a member of a team WORK ENVIRONMENT: Work is typically performed in an office or other equivalently good environment with rare reputed company of reputed company variations in temperature or exposure to reputed company conditions. Physical effort normally reputed company in clerical work or the equivalent. Work is primarily sedentary; however, occasional handling of small objects (up to approx. 10 lbs.), and occasional walking or standing may be required TRAVEL: May require limited travel for offsite meetings or training. SUPERVISORY RESPONSIBILITY: This position does not have any supervisory responsibilities. OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Apply Job!