RN Utilization Review Full-time
SouthEast Alaska Regional Health Consortium

RN - Care Coordinator - In-patient HOT JOB

apartment SouthEast Alaska Regional Health Consortium location_onSitka, AK, US
Apply Now

Pay Range:

Pay Range:$41.66 - $58.69 As part of a consortium-wide team, support and manage patient progression of care in the hospital setting, promote evidence-based protocols, ensure the appropriateness of interventions, assess patient psycho-social needs, and expedite care delivery for patients.

SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.

Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.

*********************************************************

$25K Sign On and $10K Relocation for qualified hire!

************************************************************

Key Essential Functions and Accountabilities of the Job

  • Works collaboratively with consortium wide team supporting inpatient Care Coordination and Utilization Management

  • Coordinate local CAH Swing Bed/Transitional Care program.

  • Lead local CAH Inpatient interdisciplinary team meeting.

  • Reviews all admissions to develop personalized treatment plans that are clinically appropriate, match the patients care needs and are consistent with patient choice and available resources while ensuring a timely and appropriate discharge.

  • Collaborate with providers, leadership, and clinical support team to ensure treatment plan is based upon patient need and meets criteria approved by consortium and regulatory agencies/payors.

  • Ensure ongoing documentation supports Utilization Management functions and communicate with payors appropriately.

  • Provide appropriate information to educate patients/families regarding healthcare benefits and treatment plan.

  • Assess patient to obtain relevant psycho-social information, make interventions and professional support referrals as needed.

  • Develop and communicate discharge plan with the care team and patient/family, ensuring safe and well-coordinated transition of care.

  • Support Peer Review process as part of consortium plan.

Education, Certifications, and Licenses Required

  • Current full, unrestricted Registered Nursing license in Alaska or other U.S. state required.  Bachelor’s preferred.

  • Direct Hire must have applied for an Alaska nursing license before start date.

  • Agency staff must have an active Alaska license.

  • Case Management certification by recognized certifying organization within 24 months of hire.

  • BLS.

  • ACLS.

  • PALS preferred.

  • High school diploma or equivalent required.

  • Clinical Competency required within 3 months of hire and every three years

  • High Risk Competency required within 3 months of hire and every year

Experience Required

  • 5 years clinical nursing experience

  • 1 year experience with chart review, risk management, or related quality service preferred.

Knowledge of

  • Medical record review, medical necessity/insurance guidelines, and regulatory compliance.

Skills in

  • Communication, both verbal and written

  • Strong organizational skills

Ability to

  • Work collaboratively as part of an interdisciplinary team.

  • Build relationships with colleagues, community partners, and consumers.

Physical Demands:

  • While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk; sit; use hands to finger, handle or feel and reach with hands and arms.

  • The employee is occasionally required to climb or balance; stoop, kneel, crouch or crawl. The employee must lift and/or move 50 lbs.

Required Certifications:

Advanced Cardiovascular Life Support (ACLS) - American Heart Association, Basic Life Support (BLS) - American Heart Association, Case Manager Certification - Commission for Case Manager Certification, Clinical Competency Assessment - SEARHC, High Risk Competency - SEARHC, Registered Nurse License - State of Alaska - Alaska State Board of Nursing

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us! 

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Psych Utilization Review Full-time
Centra Health

RN Utilization Review II-Behavioral Health-FT/Days

apartment Centra Health location_onLynchburg, VA
Job Description Utilization review nurse is responsible for the day to day coordination of admission criteria as it relates to healthcare needs of the patient and organization. Including knowledge of regulatory and compliance with Medicare, Medicaid and other insurance payors. This team member will communicate with a variety of clinical discipline, commercial payers, patient access, patient financial services, physician advisor and other staff members. Responsibilities Provides, initial, concurrent and retrospective reviews if assigned patients for severity of illness and intensity of service Demonstrates the ability to interpret InterQual and Milliman and Roberts criteria to ensure the patients meet admission and continued stay criteria Provides accurate and complete account authorization and details in plan notes Performs admission review on the following business day of patient's admission Involves the Physician Advisor as needed when physician-to-physician interaction is required to achieve appropriate clinical utilization for the patient Collaboratively works with the Physician Advisor to facilitate all aspects of the utilization management plan Serve as a liaison to patient accounting, patients access as it relates to authorizations and claims Demonstrates ability to communicate effectively with internal and external customers Demonstrates commitment toward customer satisfaction and patient advocacy Maintains confidentiality of patient/physician/and other team members as well as maintaining compliance with all federal/state guidelines and regulations Achieves budget length of stay (LOS) goal May perform other duties as assigned or requested and job specification can be modified or updated at any time Qualifications Required Education: Graduate of an accredited Nursing Program Preferred Education: Bachelors of Science Degree in Nursing (BSN) Required Experience: Three (3) years of experience in acute care nursing. Computers skills a must as well as excellent communication and the ability to work collaboratively with other disciplines Required Certifications and Licensures: Hold a current, active license as a registered nurse in Virginia or hold a current multistate/compact license. Hold a current, active American Heart Association Basic Life Support (AHA BLS) course completion card. Preferred Certifications and Licensures: ACMA Certification
RN Utilization Review Full-time
CareSource

Clinical Care Reviewer II- Must have Post Acute Exp-RN-MSL

apartment CareSource location_onOH
Job Summary: The Clinical Care Reviewer II - Post-Acute is responsible for conducting medical necessity reviews to determine the appropriateness of authorization for post-acute health care services including Skilled Nursing Facilities (SNF), Nursing Facilities (NF), Long Term Acute Care Hospitals (LTACH), and Inpatient Rehabilitation Facilities (IRF). This role assists with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled with a CareSource Management Group line of business, and monitors the delivery of healthcare services to ensure they are provided in a cost-effective manner. Essential Functions: Conduct prospective, concurrent, and retrospective review of post-acute admissions and related services, including outpatient services provided in the post-acute setting according to established processes. Complete clinical reviews for new and continued stays in post-acute services; assist in facilitating timely and cost-effective member discharges to the appropriate level of care. Refer cases to CareSource Medical Directors when clinical criteria are not met or when a need for a case conference is identified. Maintain knowledge of state and federal regulations governing CareSource, including state contracts, provider agreements, CareSource policies and procedures, benefits, and accreditation standards. Identify and refer quality issues to the Quality Improvement department. Identify and refer members receiving post-acute services to Care Management according to established processes, escalating new or changing member needs as necessary. Document member discharge planning needs to support coordinated care and communicate with providers, care managers/care coordinators, discharge planners, CareSource Provider Relations, and other external stakeholders to support discharge planning activities. Participate in required inter-rater reliability (IRR) audits to ensure consistency and accuracy in reviews. Attend and participate in department huddles, team meetings, and all staff meetings; review meeting minutes and/or other collateral when unable to attend. Provide guidance and support to non-clinical utilization management staff as needed. Attend medical advisement and State Hearing meetings as requested. Assist Team Leader with special projects or research tasks as requested. Performs any other job related duties as requested. Education and Experience: Completion of an accredited registered nursing (RN) degree program required Three (3) years of clinical experience required Med/surgical, emergency, acute clinical care or Post Acute Care experience preferred Utilization Management/Utilization Review experience preferred Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: Basic data entry skills and internet utilization skills Working knowledge of Microsoft Outlook, Word, and Excel Effective oral and written communication skills Ability to work independently and within a team environment Attention to detail Familiarity of the healthcare field Proper grammar usage and phone etiquette Time management and prioritization skills Customer service oriented Decision making/problem solving skills Strong organizational skills Change resiliency Licensure and Certification: Current, unrestricted Registered Nurse (RN) licensure in state(s) of practice required MCG Certification is required or must be obtained within six (6) months of hire Working Conditions: General office environment; may be required to sit or stand for extended periods of time Availability to work scheduled weekend and holiday hours to ensure continuous department coverage and support for reviews throughout the year, including all 365 days Travel is not typically required Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1
RN Manager/Supervisor Utilization Review Full-time
Personal Touch Home Aides of New York

RN Quality Review Manager- Registered Nurse

apartment Personal Touch Home Aides of New York location_onNew York, NY
RN Quality Review Manager- Registered Nurse Brooklyn, NY This a full time , in-person position based out of Brooklyn, NY . RN new grads are welcome . Pay: $90, 000- $105, 000/ annually About Us : With over 50 years of dedicated service to our communities, Personal Touch has been a trusted provider of home care. Our priority lies in ensuring exemplary patient care while fostering a supportive and empowering workplace culture for all team members. We are currently seeking compassionate and skilled nurses to join our team and continue our legacy of providing personalized and attentive care to patients in the comfort of their own home. Why Choose Us: At Personal-Touch Home Care, we are committed to creating a rewarding and fulfilling experience for our team members. Our established history and reputation provide a stable and trusted foundation for your career. Join us in positively impacting the lives of our patients and their families. As a member of our team, you will enjoy a wide range of benefits that enhance your overall well-being and support your career growth. They include: Employee Recognition Programs: We acknowledge and celebrate your contributions. Comprehensive Health Benefits: We offer an inclusive package with Medical, Dental, Vision, Accident, and Long-Term Disability Coverage to ensure access to quality medical care while promoting overall wellness. Generous Paid Time Off: We provide generous paid time off to ensure you can recharge and return to work refreshed, leading to greater productivity and job satisfaction. We support a healthy work-life balance. Retirement Benefits: We offer a 401k plan to secure your financial future and help you save for retirement. Life Insurance: We offer company paid life insurance providing peace of mind and financial protection for you and your loved ones. Mileage Reimbursement: We make sure you're compensated for your business travel. Opportunities for Professional Growth and Development: Empowering you to thrive and grow. Employee Assistance Program: Supporting the well-being of you and your family. Perks Program: Exclusive deals and offers on products, services, and experiences you need and love Job Details Overview: As a RN Clinical Manager/ Quality Review Manager , you will play a pivotal role in coordinating and managing patient care to ensure the highest standards are met. This position involves supervising clinical personnel and ensuring the delivery of quality home care services. Responsibilities: Receive case referrals and assess patient needs to assign appropriate clinicians. Review and evaluate each case, providing guidance to clinicians for effective performance. Instruct and guide clinicians to promote quality care delivery, being available to assist as needed. Review patient clinical information, including diagnosis, medications, and procedures. Assist in establishing therapeutic goals and developing care plans. Attend case conference meetings to facilitate care coordination. Conduct concurrent chart and record reviews and communicate findings to appropriate personnel. Assist in screening, interviewing, and orienting new personnel. Assist in planning and implementing in-service and continuing education programs. Contribute to the formulation, revision, and implementation of policies and procedures. Perform direct patient care duties as needed. Maintain compliance with professional standards and principles. Performs all other duties as assigned. Qualifications: Registered Nurse (RN) with current licensure to practice professional nursing in the State. Graduate of an accredited nursing school; BSN degree preferred. Two (2) years of prior home health care experience. At least one (1) year of management or supervisory experience in a health care setting, preferably home care. Demonstrates excellent observation, verbal and written communication skills. Verbal and written communication skills in English. Job type: Full-time Pay: $90, 000- $105, 000/ annually We are excited to welcome passionate and dedicated individuals to join our team at Personal Touch Home Care . We’re more than just a company, we’re a close-knit family dedicated to supporting each other’s success and well-being. Apply now and join us in making a positive impact on the communities we serve.
RN Utilization Review Full-time
Kaweah Health

RN Peer Review Coordinator

apartment Kaweah Health location_onVisalia, CA
Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care. It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community. Benefits Eligible Full-Time Benefit Eligible Work Shift Day - 8 Hour or less Shift (United States of America) Department 8710 Medical Staff Services A team-oriented and quality focused professional who is responsible for overseeing the Medical Staff Peer Review process. QUALIFICATIONS License /Certification Required: Current California Registered Nurse License BLS Education Preferred: Bachelor's degree Experience Required: Three years clinical experience in an acute care setting. Experience with Cerner EMR. Preferred: Quality management experience. Knowledge/Skills/Abilities Strong computer skills to include Microsoft Office, Word, and Excel. Exceptionally strong interdisciplinary collaboration skills. Knowledge of peer review concepts and process and risk management principles preferred. Knowledge of guidelines, healthcare standards, and regulations, (i.e.: evidence-based, CMS, TJC, AHRQ Patient Safety Indicators, Hospital Acquired Conditions) preferred. Knowledge of quality improvement methodologies and analytic tools and methods preferred. Strong communication skills, both written and verbal preferred. JOB RESPONSIBILITIES Essential Supports and coordinates the Medical Staff Peer Review committees and activities as outlined in the Peer Review and Code of Conduct policy including but not limited to: Maintains the confidentiality of patients, practitioners, and the organization. Identifies cases which meet the criteria for preliminary clinical or behavioral case review. Assists peer reviewers in obtaining or provide a complete medical record, imaging studies and other documentation reasonably required to perform Peer Review. Coordinates and communicates with physicians and/or their offices in regard to screening, scoring and assist with their presentation of select cases for peer review or unprofessional behavior review. Attends the medical staff peer review behavior meetings and other related ad hoc meetings. Provides full administrative support which includes preparation of agendas, material gathering, speaker scheduling, chair preparation, recording minutes, and coordinating follow up processes and activities. Provides data identifying the relevant practice patterns and trends of the Practitioner related to defined departmental outcomes. Maintains positive working relationships with medical staff, nursing, and ancillary services as it relates to peer review processes. Performs preliminary (RN level) case review and highlight the potentially relevant issues. Provides relevant benchmark comparisons of the Practitioner under review. Identifies instances of clinical performance and/or unprofessional conduct regarding non-Practitioner staff. Facilitates timely and accurate triage of Medical Staff related Risk Events. Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area. Performs other duties as assigned. Pay Range $46.44 -$69.66 If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.
RN Utilization Review Full-time
Baptist Memorial Health Care

RN-Utilization Review

apartment Baptist Memorial Health Care location_onMemphis, TN
Overview Job Summary Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned. Responsibilities Utilization Review Discharge planning Readmission Reduction Participation Payer Communication and denial reduction Completes assigned goals. Specifications Experience Minimum Required RN with at least one (1) year of clinical experience Preferred/Desired RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting Education Minimum Required Diploma or Associate Degree in Nursing Preferred/Desired BSN or MSN Training Minimum Required Preferred/Desired Certified Case Manager Special Skills . Minimum Required Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations. Preferred/Desired Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations. Licensure RN Minimum Required RN Preferred/Desired RN;CCM;ACM