MAKE Corporation
https://makecor.wpengine.com/wp-content/uploads/2019/08/Logo@2X.png
http://www.makecor.com
http://www.makecor.com
true
19002- Registered Nurse
Richardson, TX 75082 US
Posted: 01/17/2023
2023-01-17
2023-04-22
Industry: Other
Job Number: 39429
Job Description
Registered Nurse
#19002
Location: RICHARDSON, TX
Duration: 6 Months+
Job Responsibilities:
ESSENTIAL FUNCTIONS:
JOB REQUIREMENTS:
#19002
Location: RICHARDSON, TX
Duration: 6 Months+
Job Responsibilities:
- This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions for Medicare. Creates, reviews and documents clinical decision-making criteria for case submission to Independent Review Entity.
ESSENTIAL FUNCTIONS:
- Reviews and evaluates clinical criteria against regulatory policies for accurate decision making
- Creates clinical packets for submission ensuring correct use of utilization management, quality review, clinical, and non-clinical quality improvement.
- Monitors and participates in clinical case audits. Evaluates results, prepares reports on findings, and communicates outcomes to leadership
- Provides necessary administrative support to assist Medical directors and staff in clinical case reviews
- Communicates trends and overall program performance to management.
- Participates on various related committees as necessary.
- Communicate and interact effectively and professionally with co-workers, management, customers, etc.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
JOB REQUIREMENTS:
- Registered Nurse (RN) or LPN with unrestricted license in Texas.
- 3 years clinical experience with 2 years experience in utilization review, case management, quality assurance
- Clinical knowledge and knowledge of managed care principles - Medicare and Medicaid
- Clinical analysis skillset to include clinical decision-making review and application of clinical criteria
- Analytical, verbal and written communications skills.
- Must be proficient in MS Office (Excel and Adobe included)
- Must be PC, laptop proficient
- CMS, NCQA, Medicaid knowledge is a plus
Job Requirements
ARRAY(0x7f217866f6e0)
