Las Vegas RN Onsite Utilization Review Nurse - $2K Sign On Bonus
Location: Las Vegas Nevada
Description: CareNational Healthcare Services, LLC is in need of Las Vegas RN Onsite Utilization Review Nurse - $2K Sign On Bonus right now, this job will be placed in Nevada. More details about this job opportunity please read the description below. RN Onsite Utilization Review Nurse - Managed Care
Las Vegas, NV
EXCELLENT BENEFITS - Now offering a $2,000 Hire on Bonus!!!! - Call for details!
Job Summary:
The Utilization Review Nurse is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic) This position is responsible for all aspects of the utilization review function, including overseeing the daily census which includes the coordination of hospital discharge calls, performing initial and continued stay reviews to ascertain medical justification for hospitalization, appropriate discharge planning and other designated medical services. This position will identify appropriate providers and facilities throughout the continuum of care ensuring that the care is cost effective and of high quality. Additionally, this position is responsible for identifying potentially high dollar and complex patients who may benefit from case management intervention.
Position Description:
As a UM Review Nurse you will utilize your clinical skills to facilitate and coordinate services for health plan members that are hospitalized or recently discharged from acute, skilled and long term care settings. You will assist the provider in identifying appropriate options for the level of care that will assist the member in achieving optimum stability of health. You will telephonically review inpatient hospital admissions and assist with the coordination of discharge planning needs. You will obtain the information necessary to assess a member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs. The UM Review Nurse will evaluate the options and services required to meet the member's health needs, in support and collaboration with disease management interventions. The nurse will perform prospective, concurrent & retrospective review of inpatient, outpatient, ambulatory & ancillary services requiring clinical review including all levels of appeal requests. Performs concurrent review to assure appropriateness of admission, continued inpatient/acute rehabilitation/SNF status, and discharge using established Milliman guidelines or industry standards. Collect pertinent documentation and conduct medical services review applying appropriate criteria, including national standardized criteria and local plan rules and guidelines. Consult with Medical Director as appropriate for all requests requiring MD approval or not meeting criteria for approval. Make referrals as indicated to case management, disease management, or behavioral health. Collaborate with the Disease Management, Quality Management, and Case Management departments in the development of protocols and guidelines designed to standardize care practice and delivery. Seek out opportunities to improve HEDIS, NCQA, URAC or general accreditation and QI activities.
This position has a primary responsibility to establish medical necessity and length of stay as authorized by the plan This position will be working with members admitted to healthcare facilities with ailments at various levels of acuity. This is a field based position and will be working at various on-site facilities including hospitals and skilled nursing facilities.
Qualifications:
Must also have a valid, unrestricted Registered Nurse license in the State of Nevada.
Requires a minimum of 2-5 years of hospital critical care background (ICU, ER).
Case Management experience in a health plan or provider setting and CCM highly preferred.
Must be a high energy individual, willing to work in a field based position, with exceptional problem solving abilities.
Must also possess good computer literacy (MS Office) and typing skills.
Bilingual in Spanish is a plus.
The Reward:
How about $25/month health insurance with LOW deductible, 401k plan and almost a FULL month of paid time off your first year?
You will have the ability to work independently, but part of a dynamic case management team and focus your efforts towards the care of the organizations membership. The smaller plan membership affords you the opportunity to provided focused care. You will be rewarded with a highly competitive salary and exceptional benefits including a generous PTO plan, Pension and 401k plans, low cost comprehensive Health, Dental, Life, Vision plans and more.
CareNational is an independent consulting and personnel management firm that focuses in the case/medical management area of healthcare.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to CareNational Healthcare Services, LLC.
If you interested on this job just click on the Apply button, you will be redirected to the official website
This job starts available on: Mon, 27 Aug 2012 05:54:32 GMT
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