Utilization Review Nurse (RN)
Posted: January 16, 2017
Reference ID: 1023672647
This position is to support the Network Inpatient Initiatives to improve our member's transition and outcomes throughout the inpatient care process. The position will have the below main functions:
1. This position will allow for a more flexible response to increased work volume, staffing challenges and improved discharge and transition of care planning. Network Nurse Case Manager covers duty assignments as directed for various IPA's. Coverage assignments are directed to assist with new Medical Management Network Inpatient Initiatives across the Network along with cover of nurse case managers who are on PTO, leave, or assigned other temporary duties etc...
Network Nurse Case Manager covers duty assignments as directed for various IPA's. Coverage assignments are directed to cover nurse case managers who are on PTO, leave, assigned other temporary duties etc. Most assignments are temporary and are directed to support multiple IPA staffing needs. Duties are relegated to fill in for Concurrent Review Case Managers at local Acute Hospitals, Skilled Nursing Facilities and Pre-Certification Authorization/referral review Nurse duties. Assignments can be either in a hospital setting or at the IPA/Medical Group Office. **Under the prior experience below if candidate has strong experience in only one area will consider for position.
Ø CA Licensed RN or LVN
Ø 1 - 2 years managed care experience
Ø 1 plus years nursing experience in an Acute Hospital setting (Med/Surg, Tele, ICU) or like setting.
Ø Willingness to work at various job sites dependent on Network needs
Needed Prior Experiences
Ø Ability to perform concurrent review case management of patients in an Acute or SNF setting (utilization/clinical review and discharge planning)
Ø Ability to perform prior authorization/referral case management duties in the managed care setting (Specialty MD referrals, DME/Injectables referrals, Surgery Procedure referrals)
What are the hours? ( Training hours?) Work hours generally 8:30 am to 5 pm. No weekends. Training is dependent on prior experience, maybe 1 - 2 week. Trying to find persons who already have this skill set and just need to learn our process.
Will you be interviewing (face to face or phone) likely phone screens only, possible face to face if needed
Please confirm the worksite location - Various location dependent on need. Like out float case managers
Non IT Contractor
What Segment will this Contractor(s) Support?
Is this position for TriCare related work, and if yes, what pay grade equivalency?
No - This position is not TriCare related
If this is Tricare related, does this position require National Agency Check (NAC) clearance?
Minimum Education Requirement
Highschool/GED or equivalent
Client Relationship Consultant
Central Order Management
If you are interested please send your resume to Anthony at email@example.com or cal me at 925-349-0308