Tampa, FL (us)
Found in Wide_Offers - POSITION TITLE: Pre-Certification Reviewer JOB NUMBER: 700-023 DEPARTMENT: POSITION TITLE:  Pre-Certification Reviewer JOB NUMBER: 700-023 DEPARTMENT:  Utilization Management     ________________________________________________________________________   GENERAL PURPOSE: The Pre-Certification Reviewer is responsible for the pre-certification of Plan determined procedures utilizing approved criteria. ESSENTIAL DUTIES AND RESPONSIBILITIES: Evaluates requested services following Plan approved criteria. Demonstrates effective communication methods and skills, using lines of authority appropriately. Establishes a relationship with providers in order to determine/provide needed services for members Arranges discharge planning services prior to pre-planned admissions when available. Acts as liaison and member advocate between the member/family, physician and facilities/agencies. Maintains accurate record of pre-certification decisions. Performs decisions within time frames required by regulatory agencies. Adheres to quality standards and confidentiality policies and procedures. Ensures compliance with all state and federal regulations and guidelines in day-to-day activities. Adapts to changes in policies, procedures, new techniques and additional responsibilities. Performs other duties as assigned. QUALIFICATIONS AND REQUIREMENTS:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE: Florida licensed RN or LPN required; minimum of two to three years varied clinical experience required; managed care experience preferred; or an equivalent combination of education, training and experience. NECESSARY KNOWLEDGE, SKILLS AND ABILITIES:  Ability to: work from designated office for collaborative/interactive fulfillment of duties; concentrate in an open-office ?cubicle? environment; appropriately and directly interact with other staff members and/or outside associates; perform telephone and/or computer work for extended periods of time; operate office equipment such as computer, telephone, and copy/scan/fax machine; attend and participate in meetings via phone, computer, or in person. Ability to read and interpret documents and calculate figures and amounts.  Excellent oral and written communication skills including good grammar, voice and diction.  Proficient in MS Office with basic computer and keyboarding skills.   Excellent customer service skills (friendly, courteous and helpful).   LICENSING AND CERTIFICATION: CurrentFlorida licensed RN or LPN required. PHYSICAL DEMANDS:  The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit.   The employee frequently is required to manipulate or use objects, equipment, tools, and/or controls. May require specific vision abilities to perform this job.   Ability to lift, carry or exert items or objects of reasonable weight. WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Attendance at employer worksite is an essential job requirement. The noise level in the work environment is usually moderate. For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office environment. ADDITIONAL INFORMATION:  The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. The duties listed above are intended only as illustrations of the various types of work that may be performed.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position.  We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
Salary: N/AJobs Pre-Certification Reviewer Nurse* »
Stockton, CA (us)
Found in Wide_Offers - Hospice serves patients wherever they call home. It may be in a hospital, nursing home, assisted living RN Case Manager The mission of Community Hospice is to provide compassionate and quality care, education and support to terminally ill patients and their families, regardless of ability to pay. Community Hospice serves patients wherever they call home. It may be in a hospital, nursing home, assisted living facility, or at the Alexander Cohen Hospice House. Community Hospice of Modesto, CA offers you the unique opportunity to make a valuable contribution in a supportive work environment. The RN Case Manager works under the supervision of the Branch Administrator to provide skilled nursing assessment, care planning, and interventions in accordance with plan of care in order to maximize the comfort and quality of life of hospice patients and families. RN Case Manager Job Responsibilities As the RN Case Manager, you will coordinate communication between members of the Interdisciplinary Team, including patient/family and attending physician. This position works 8 hour shifts 5 days per week. Additional responsibilities of the RN Case Manager include: Admissions of new patients, which includes assessment, planning, implementation, and evaluation phases of the nursing process, evaluations of patient appropriateness for hospice services, and consultations to explain hospice services, as requested by the Branch Administrator. Perform scheduled home visits to assess needs; teach caregivers pain management, symptom control and patient care skills; and provide physical, emotional and spiritual support to the patient/family. Maintain regular communication with interdisciplinary team regarding patient status or any unusual or problematic patient/family issues. Initiate communication with attending physicians and other team members and other community agencies as needed to coordinate plan of care and use of resources for patient/family. Maintain up-to-date patient records so that problems, goals, and interventions are accurately and clearly documented and changes in the plan of care are reflected as they occur. Attend regularly scheduled Interdisciplinary Team Meetings to review patient/family needs, problem solve and cover unique issues, share professional support and exchange feedback aimed toward enhancing professional growth. Accept responsibility for coordinating physical care of the patient, including Home Health Aide and Licensed Vocational Nurse assignment and supervision, teaching primary caregivers and employed caregivers, teaching facility staff, or by providing direct care as appropriate. Assure continuity of care for patient in all settings. Attend death events and provide appropriate support at time of death.
Salary: $36.00 - $52.00 /HourJobs RN Case Manager »
Oakland, CA (us)
Found in ZipRecruiter - California RN / Registered Nurse * 2+ years of experience of Utilization Management / Utilization Review / Prior Authorization / Precertification / Concurrent Review / Pre-Auth / Pre-Cert / for ...Jobs Utilization Review Nurse (RN) Medical Group »
Alhambra, CA (us)
Found in ZipRecruiter - Position UM Review Nurse - LVN Description To implement the effectiveness and best practices of ... decisions for the precertification process. * Identifies opportunities to promote quality ...Jobs UM Review Nurse - LVN »
Glendale, CA (us)
Found in ZipRecruiter - Conducts precertification,continued stay review, care coordination, or discharge planning ... Nurse MedicalManagement Sr. Responsible to serves as team lead for nursing staff who collaborate ...Jobs Registered Nurse »
Mendota Heights, MN (us)
Found in ZipRecruiter - Nurse Medical Mgmt Ld - Andover, MA (in the office) Location: United States New Requisition ... Conducts precertification, continued stay review, care coordination, or discharge planning for ...Jobs Registered Nurse »
Colorado Springs, CO (us)
Found in ZipRecruiter - ... precertification, continued stay review, care coordination, or discharge planning for ... N license to practice as a health professional in in state of residence AND be eligible for ...Jobs Registered Nurse »