Vakante Jobangebote finden Sie unter Projekte.
Referral Nurse - Managed Care Job
Eingestellt von Yoh
Gesuchte Skills: Client
Projektbeschreibung
THE BIG PICTURE:
The Referral Nurse will be responsible for receiving and reviewing referral requests to ensure appropriate utilization and timely delivery of health care services and providing a linkage system for a standard operational process for the flow information between the member, or legal representative, and appropriate providers through communication, coordination and monitoring of services.
What You'll Be Doing:
- Referral Management responsibilities and functions include
- Supervises daily management of TAT for Case Management and UM Technician staff in collaboration with the Lead UM Technician.
- Supervises daily management of the error reports for Case Management and UM Technician staff in collaboration with the Lead UM Technician.
- Ensures that all STAT/URGENT Expedited requests are reviewed and that a final determination is completed and communicated within the required regulatory or internal guidelines
- Identifies potential transition of care needs and makes necessary referrals to the care management team to follow-through and meet these needs, if identified
What You Need to Bring to the Table:
- RN or LVN license required.
- CCM certification preferred.
- Two (2) to five (5) years managed care/IPA experience.
- Solid knowledge of general IPA operations.
- Solid experience using Interqual or Milliman guidelines.
- Computer skills using Outlook and other Microsoft Office products.
WHAT ARE YOU WAITING FOR? APPLY NOW!
RECRUITER: Jennifer Yerkes
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Please contact us if you are an individual with a disability and require accommodation in the application process.
J2W: HC
MONJOBJ2WSWHLTH
Ref:
SFSF: HC
Projektdetails
-
Einsatzort:
Ontario, Vereinigte Staaten
-
Projektbeginn:
asap
-
Projektdauer:
Keine Angabe
- Vertragsart:
-
Berufserfahrung:
Keine Angabe
Geforderte Qualifikationen
-
Kategorie:
IT Entwicklung