Bakersfield, United States
You apply directly with the employer. We never charge applicants.
Bedford, United States
Milwaukee, United States
Sioux Falls, United States
Casa Grande, United States
Tucson, United States
$82K–$128K/yr
Estimate — the employer hasn't published pay.
Based on 780 similar mid-level Nursing & Care jobs in United States that show pay. The range is the middle half of their posted pay (25th to 75th percentile), not an offer — ask the employer for the real range.
Nursing & Care salaries →Salary: Pays up to $39/hr ($2,000 sign on bonus) with great benefits package
Shift: Monday to Friday 8:00AM to 5:00PM
• Performs review of requested outpatient and elective, prospective inpatient medical services.
• Under the direction of the UM Clinical Supervisor coordinates and refers KHS members for services which are carved out of KHS medical coverage.
• Assists in the authorization and processing of automatic referral requests.
• Responsible for written and verbal communication with contract providers and internal KHS staff to promote timely coordination of care and dissemination of KHS policies and procedures.
• Collaborates with the KHS Member Service Department and the Provider Relations Department regarding quality of care and other grievance issues in order to facilitate timely problem resolutions.
• Utilizes Milliman and Medicaid criteria to review DME, home care, rehab and SNF referrals for medical necessity and benefit coverage while processing referral request.
• Identifies and refers quality of care, coordination of benefits, and third party liability issues as appropriate.
• Maintains knowledge of covered benefits for all programs.
• Shares information as necessary with appropriate Case Manager, Disease Management Nurse, or Social Worker.
• Identifies and refers cases appropriate for Case Management evaluation.
• Identifies authorization issues and brings those requiring attention to the UM Supervisor.
• Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required;
• Experience working with patients and caregivers regarding self-care and disease management required;
• Experience working in case management or care coordination is a plus
• Knowledge of Kern County Community resources for seniors and people with disabilities is a plus
• Bachelor’s Degree from an accredited school or equivalent in Nursing, Health Administration or related healthcare field preferred
Interested in being considered?
If you are interested in applying to this position, please contact Edgar Pablo @ 407-478-0332 ext 114 and click the Green I’m Interested Button to email your resume.
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!