Job Description
Daily Responsibilities:
Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
Conduct discharge planning
Educate providers on utilization and medical management processes
Provide clinical knowledge and act as a clinical resource to non-clinical team staff
Enter and maintain pertinent clinical information in various medical management systems
Qualifications
Requirements:
RN license & associate’s degree in Nursing
Must have discharge planning experience
Must have inpatient hospital experience (MED-SURG is ideal) – at least about 2 years
Computer skills! Must be comfortable & able to learn computer systems
Preferably have:
Interqual or Milliman experience
Utilization review experience
Case Management experience
Hours for this Position:
Flexible - roughly 8:00-5:00 or 8:30 to 5:00
Advantages of this Opportunity:
Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Additional Information
Want More Information?
• If you are interested in applying to this position, please contact Ashley Greene @ 407-478-0332 ext 169 or email and click the Green "I’m Interested" Button to email your resume.
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!