Clinical Nurse - Utilization Management*
Location: Las Vegas Nevada
Description: QuarterLine is at the momment seeking for Clinical Nurse - Utilization Management* right now, this vacancy will be placed in Nevada. For detail informations about this vacancy opportunity please give attention to these descriptions. QuarterLine Consulting Services (QuarterLine) provides professional health care staffing services to military hospitals and health clinics across the United States. We are currently seeking a Clinical Nurse -Utilization Management at Nellis Air Force Base in Las Vegas, Nevada.
Responsibilities:
The duties may include but are not limited to the following:
The Clinical Nurse will provide Utilization management activities and functions by using MTF specific quality improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the facility. Prioritizes accordingly based on high dollare, high volume or problem prone diagnoses. Identiifies gaps between desired and actual program outcomes and develops an action plan to fix gaps. Deternimes effectiveness of plan and continually evaluated the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the right care, at the right time, in the right place, with the right provider, at the right cost. The Clinical Nurse will generally work between the hours of 7:30am to 4:30pm.
Qualifications:
Education. Shall be a graduate from an associate (ADN) or baccalaureate degree (BSN) program in nursing accredited by a national nursing accrediting agency recognized by the US Department of Education. License. Maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction. Certification. Certified Professional in Healthcare Management (CPHM) by McKesson or a clinical specialty recognized by American Nurses Credentialing Center -OR- certification eligible with 3 years for ADN or 2 years for BSN experience in utilization management/utilization review or in broad-based clinical nursing.
Must have knowledge in the following:
Must have experience in Patient Advocacy, Patient Privacy, and Customer Relations; performing prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in, collection and recovery from multiple insurance carriers; inpatient unit rounds for clinical data collection; providing documentation for appeals or grievance resolution; applying critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations; applying problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to QuarterLine.
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This vacancy starts available on: Tue, 21 Aug 2012 00:27:48 GMT