Job Description
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues
Determines medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level
Position Summary:
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively
manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues
Duties:
Determines medical necessity/ appropriateness
Facilitates optimal outcomes
Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action
Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy
Optimize total costs
Implementation and evaluation of policy based on usage and program directives
Educate/empower colleagues at all levels to enable decision making at most appropriate level
Required Qualifications:
RN with current unrestricted Virginia state licensure required.
3 years clinical experience (for example med surg or behavioral health)
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written.
Preferred Qualifications:
Managed Care experience, Case Management experience in an integrated model
5 years clinical practice experience
Bilingual
Education:
RN with VA current unrestricted Virginia state licensure required.
Associate's or Bachelor's in Nursing
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