Clinical Nurse - Utilization Management
Location: Dover Delaware
Description: QuarterLine is at present recruited Clinical Nurse - Utilization Management right now, this job will be placed in Delaware. Further informations about this job opportunity please give attention to these descriptions. QuarterLine Consulting Services (QuarterLine) provides professional health care staffing services to military hospitals and health clinics across the United States. We! are currently seeking a Clinical Nurse - Utilization Management at Dover Air Force Base (AFB) in Delaware.
Responsibilities:
The Clinical Nurse will provide Utilization management activities and functions by using MTF specific quality improvement processes to identify areas for review from data, suspected problem areas, and input from departments/services within the facility. Prioritizes accordingly based on high dollare, high volume or problem prone diagnoses. Identiifies gaps between desired and actual program outcomes and develops an action plan to fix gaps. Deternimes effectiveness of plan and continually evaluated the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the right care, at the right time, in the right place, with the right provider, at the right cost. Work hours will be 7:30am to 4:30pm.
Qualifications:
Must hav! e experience in Patient Advocacy, Patient Privacy, and Custome! r Relations; performing prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in, collection and recovery from multiple insurance carriers; inpatient unit rounds for clinical data collection; providing documentation for appeals or grievance resolution; applying critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations; applying problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.
Education. Shall be a graduate from an associate (ADN) or baccalaureate degree (BSN) program in nursing accredited by a national nursing accrediting agency recognized by the US Department of Education.
License. Maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nu! rsing as a registered nurse in any US state/jurisdiction.
Certification. Certified Professional in Healthcare Management (CPHM) by McKesson or a clinical specialty recognized by American Nurses Credentialing Center -OR- certification eligible with 3 years for ADN or 2 years for BSN experience in utilization management/utilization review or in broad-based clinical nursing.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to QuarterLine.
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This job starts available on: Wed, 20 Nov 2013 21:22:37 GMT