Concurrent/Utilization Review Care Manager - Registered Nurse
Location: Denver Colorado
Description: Physician Health Partners, LLC is at present looking to employ Concurrent/Utilization Review Care Manager - Registered Nurse right now, this job will be placed in Colorado. More details about this job opportunity kindly read the description below. Collaborate! Innovate! Make a Difference!Physician Health Partners, a premier healthcare management provider, is seeking a detail oriented and collaborative Concurrent/Utilization Review Care Manager- RN to be responsible for providing a broad range of Care/Case Management Services to identify risk stratified, managed care patients in order to monitor appropriate utilization and quality of medical and community services. The ideal candidate will work closely with the organization's physicians (PCP/Specialists) and patients at all levels of care to improve coordination, support clinical outcomes and increase satisfaction for all involved. POSITION OVERVIEW:Reviews appropriate utilization of medical services, quality of care, risk management and provides intervention for care management. Assists the working committees in utilization and case management. Here is what you'll get to do: Review concurrent and retrospective inpatient and/or subacute admissions for utilization based on Milliman Care Guidelines, quality improvement, risk management, and discharge planning needs. Develop and maintain a good working relationship with medical and hospital staff, ancillary service providers, patients and their families. Seeks appropriate medical and/or staff intervention in a timely manner to assure problem prevention and resolution. Assess patients medical and psychosocial needs to develop, communicate and implement a comprehensive plan of care in collaboration with the healthcare team. Document concurrent and retrospective reviews, care management interventions and discharge plans in appropriate care management system to track utilization, variance and quality indicators. Here is what you'll need to succeed: Graduate of accredited school of nursing with BSN (may be waived for individual who has an RN, LPN degree or diploma associate degree in nursing and demonstrates experience in quality improvement, utilization review or discharge planning). 3-5 years clinical nursing experience in acute care. Previous utilization/case management discharge planning experience utilizing Milliman Care Guidelines. Must have a valid drivers license and reliable transportation. RN (BSN preferred) with current unrestricted Colorado license. Knowledge of NCQA, QA, Medicare/Medicaid guidelines. Knowledge of community resources/agencies. Knowledge of program and workflow development, process improvement and implementation procedures. Hours of Work: M-F, 8:00 AM to 5:00 PM (Home Based) Travel: 50%-75% Weekend Requirements: Rotation, 4 weekends per year BENEFITS: PHP is dedicated to supporting our employees by promoting a healthy work-life balance, while providing opportunities for growth. We offer competitive salaries and a full range of benefits, along with a professional atmosphere, and a fabulous location in the heart of downtown Denver right on the 16th St. Mall, with easy access to public transportation. PHP offers a comprehensive benefits plan and works hard to respond to our employees needs when developing and implementing new programs.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Physician Health Partners, LLC.
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This job starts available on: Wed, 22 Aug 2012 10:50:03 GMT
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