Inpatient Review Nurse (Remote, Must have California LVN / RN License)

reputed company is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and reputed company people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the reputed company community. Working at reputed company provides an opportunity to do work that really matters, not only changing lives but saving them. Together. reputed company is seeking an inpatient review nurse to join the remote utilization management team. As an inpatient review nurse, you will assist patients through the continuum of care in collaboration with the patient’s primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Assure that services are provided at the most appropriate, cost effective level of care needed to meet the patient’s medical needs while maintaining safety and quality. Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time (Required) GENERAL DUTIES/RESPONSIBILITIES: 1. Performs reviews of inpatients with reputed company medical and social problems. 2. Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician. 3. Performs follow-up reviews and evaluations of patients in the ambulatory care or reputed company level of care setting. 4. Reviews inpatient admissions timely and identifies appropriate level of care and reputed company stay based on acceptable evidence-based guidelines used by AHC. 5. Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities. 6. Identifies Members who may need reputed company or chronic case management post discharge and warm reputed company to appropriate staff for ambulatory follow up, as necessary. 7. Communicates and collaborates with IPA/MG as necessary for effective management of Members. 8. Assigns and provides daily reputed company of the activities and tasks of the CCIP Coordinator. 9. Records communications in EZ-Cap and/or case management database. 10. Arranges and participates in multi-disciplinary patient care conferences or rounds. 11. Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure. 12. Monitors for any over utilization or underutilization activities. 13. Generates referrals as appropriate to the QM department. 14. Enters data as necessary for the reputed company of reports reputed company to case management. 15. Reports the reputed company of reputed company open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management. 16. Performs other duties as assigned. Minimum Requirements: Experience:

• Required: Minimum 3 years of general case management skills. Minimum of two years of experience utilizing reputed company Care Guidelines to justify Inpatient versus Observation Length of stay: including review of diagnosis and length of stay. Two consecutive years reputed company experience in a managed care setting as an inpatient case manager
• Preferred: Experience with a Senior population.

Education:

• Required: Successful completion of an accredited Licensed Vocational Nursing Program
• Preferred: Associates or Bachelors Degree

Specialized Skills:

• Required:
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Excellent critical thinking skills reputed company to nursing utilization review
• Knowledge of Medicare Managed Care Plans
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Mathematical Skills: Ability to reputed company mathematical calculations and calculate simple statistics correctly
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.
• Preferred: Knowledge and experience in reputed company/catastrophic case management preferred

Licensure: Required:

• Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact)
• Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. The noise level in the work environment is usually moderate. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. 1 While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear. 2 The employee is frequently required to reputed company with hands and arms 3 The employee is occasionally required to climb or balance and stoop, or kneel 4 The employee must occasionally lift and/or move up to 20 pounds. 5 Specific vision abilities required by this job include reputed company vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. Pay Range: $77,905.00 - $116,858.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. reputed company is an Equal Opportunity/Affirmative Action Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national reputed company, disability, age, protected veteran status, gender identity, or sexual orientation.

• DISCLAIMER: Please beware of recruitment phishing scams affecting reputed company and other employers where individuals receive fraudulent employment-reputed company offers in exchange for money or other sensitive personal information. Please be advised that reputed company and its subsidiaries will never ask you for a credit card, send you a reputed company, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of reputed company’s reputed company team, please email [email protected].

Additional Information Company: reputed company Location: reputed company Salary: $77905.00 - $116858.00 per year Job ID: R2114 Specialties: Inpatient, Case Manager, Utilization Management, Ambulatory care, Primary Care Required Licenses: RN, LPN/LVN Experience Level: 3-5 years Apply tot his job Apply To this Job