Outpatient Care Nurse

Company: The CSI Companies ( Learn More )

General Information
US-MO-Columbia
N/A
High School
Full-Time
Not Specified
Not Specified
False
False
Job Description

The CSI Companies is currently partnering with a premier health care service provider in search of a Outpatient Nurse Care Manager for their Columbia location.

Pay: Flexible depending on experience

Schedule: M-F Business Hours

JOB SUMMARY

Oversees the utilization management activities by evaluating the necessity and efficiency of services through systematic monitoring of medical necessity and quality. while maximizing the appropriate level of care that correlates to the member's benefit plan.

ESSENTIAL FUNCTIONS

  • Reviews and collects medical information in order to determine the medical necessity of services requested by applying specific medical criteria.
  • Ensures that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized.
  • Initiates and continues direct communication with health care providers involved with the care of the member to obtain complete and accurate information.
  • Identifies apporpriate clinical settings for services being requested.---Identifies and refers cases appropriate for case management.
  • Identifies potential quality of care issues and refers to Quality Department.
  • Ability to follow and apply all necessary regulatory requirements for assigned market.
  • Determines appropriate utilization management of services requested.
  • Assists with implementation of healthcare initiatives in market.
  • Assists in implementation of specific strategies that improve the quality and outcomes of care.
  • Performs other duties as assigned.
  • MINIMUM QUALIFICATIONS

  • A High School or GED Required
  • 2+ years of experience in an acute clinical/surgical position(s). current experience in utilization management to include pre-authorization. utilization review. concurrent review. discharge planning. and/or skilled nursing facility reviews
  • Care management experience in a managed health care setting Preferred
  • Licenses and Certifications

  • Licensed Practical Nurse (LPN)
  • How to Apply:Please send your resume in Word or PDF format to: [Click Here to Email Your Resum√©]Copy and Paste the following job title and code and place it in the subject line of your email so we can identify the job: Outpatient Care Nurse (#155935-MH2479)
    Job Requirements