Waiver Utlization Management Nurse (RN)
Location: Charleston West Virginia
Description: APS Healthcare is employing Waiver Utlization Management Nurse (RN) right now, this job will be placed in West Virginia. More details about this job opportunity kindly see the descriptions. Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people c! overed by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs.
Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advantage plans to people with Medicare. We partner with providers in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible.
For more information on Universal American, please visit our website at www.UniversalAmerican.com.
We are seeking a Waiver/Medical Utilization Review RN to ! join this exciting program in our Charleston office. This indi! vidual will primarily work with the Waiver and Medical programs to determine and track appropriate authorization for requested services.
Essential Functions:
1.Perform case reviews of service requests and apply national criteria/state policies
across multiple programs including the Aged and Disabled Waiver, Medical services
and Intellectual/Developmental Disability Waiver programs
2.Develop and disseminate information to providers regarding national criteria, prior authorization process, and case resolutions.
3.Assist in creating and updating policy and procedure manuals, maintain on-going communication with WV Medicaid providers, and assist the with program development activities.
Education:
- Associate?s degree in Nursing required. Bachelor's degree in Nursing preferred
- Current, unrestricted RN license in the state of West Virginia required
- Advanced nursing certification related to UM/CM a pl! us
- Minimum 3 years clinical experience required.
- Previous experience in providing medical services (inpatient and/or community) and utilization management/review and case coordination required.
- Medicaid/Public Sector service preferred.
- Prior public speaking/facilitation of trainings is preferred.
- Strong clinical assessment skills, consistent with state licensure scope of practice requirements.
- Excellent written & verbal communication skills.
- Proficient in Microsoft Office and Internet/Web Navigation.
- Prioritization and organizational skills required.
- Ability to assess patient health status, consistent with state licensure scope of practice requirements.
- Ability to integrate data and evaluate to design meaningful interventions.
- Must be able to prioritize and target interventions, consistent with state licensure scope of practice requirement! s designed to support long term behavioral change.
- Strong anal! ytic & problem solving capabilities needed.
- .
If you were eligible to this job, please email us your resume, with salary requirements and a resume to APS Healthcare.
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: Wed, 16 Oct 2013 09:21:12 GMT
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.