Are you tired of being on your feet daily?
Are you looking for a less physically demanding opportunity that leverages your clinical expertise?
We have the position for you:
IMMEDIATE DIRECT HIRE OPPORTUNITY AVAILABLE with a national care management and quality improvement organization. Use your clinical nursing experience to create positive outcomes for members utilizing a holistic, member centric care management solution. Responsibilities include the review of medical records using InterQual Criteria. Reviewers must possess critical thinking and decisiveness when determining medical appropriateness while also maintaining production goals and QA standards.
*Salary includes great benefits (PTO, holiday pay, medical/dental/vision insurance) and opportunities for advancement within organization.*
- Active Florida RN or LPN licensure required.
- Knowledge of InterQual criteria preferred.
- Minimum of two years of recent clinical nursing in an acute health care environment.
- Minimum of one year of Utilization Review.
- Minimum of one year UR, QA, Case Management or related experience.
- Medical record abstracting skills required.
- Knowledge of the organization of medical records, medical terminology, disease process.
- Ability to work in a team environment.
- Flexibility and good organizational skills needed.
- Must be proficient in Microsoft Office.
- Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determines if the plan of care is followed in a timely manner and that the medical record documentation supports the delivery of quality care.
- Makes the decision to approve a record or initiate a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
- Abstracts review related data/information accurately and timely on appropriate review tool by the appropriate means.
- Accurate and timely submission of all administrative and review related documents to appropriate parties.
- Ongoing reassessment of review process to offer opportunity for improvement and/or change.
- Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
- Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
- Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
- Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following client
- Cross-trains to perform duties of other contracts within the network to provide a flexible workforce to meet client/consumer needs.
***The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee must have the ability to read and interpret data and complex information and function in a team environment. In addition, the employee is required to sit for extended periods of time; key and/or control objects; occasionally lift and/or move objects weighing up to 15 pounds; and use a personal computer.
Candidates may contact Melanie Parrish at 804.433.1116 or email their resume directly to: firstname.lastname@example.org.