We have partnered with a major managed care employer. Positions in north west Phoenix and Tempe. Temp to hire positions! Care Coordinator – RN – up to $33 an hour
Need at least 2 years of medical/surgical experience and preferably utilization management experience
Send resume directly to: Gary.Rice@trcstaffing.com
RN Care Coordinator
Conducts Medical / Surgical or Behavioral Health medical necessity reviews for continued stay reviews, care coordination, discharge planning, and post-nursing calls. Conducts review and pre-screening reviews for Medical Director prior to non-certification. Initiates discharge-planning care coordination and post-service nursing calls. Utilizes clinical and analytical skills to identify and refers cases to Case Management or Disease Management as appropriate. Provides support to non-clinical staff on clinical and coding questions. Conducts pre-admission screening assessments.
Education & Experience Required
Registered Nurse, Licensed Clinical Social Worker, or Licensed Clinical Psychologist (Ph.D./Psy.D.) with current unrestricted license in appropriate state
2+ years experience in Medical / Surgical clinical nursing or 2+ years Behavioral Health experience in inpatient or outpatient setting
Proficiency in medical data entry and Microsoft Word
Exceptional oral communication skills
5 yrs. Medical / Surgical clinical nursing or Knowledge of Behavioral Health Levels of Care
2+ years Managed Care experience
Knowledge of Intensity of Service and Severity of Illness indexes; InterQual Imaging Criteria, Procedural Criteria, Level of Care, and Length of Stay; International Classification of Diseases; Current Procedural Terminology; and Health Care Financing Administration Common Procedure Coding System; and American Dental coding
Coordinates discharge planning, completes necessary authorizations, and conducts post-service nursing calls.
Conducts Utilization Management continued stay and inpatient reviews to assess medical necessity.
Researches and collaborates with appropriate community resources to support discharged beneficiaries.
Prepares more complex cases for Medical Director and Peer Review. Collaborates with Medical Director on decision-making.
Utilizes clinical and analytical skills to identify and refers cases to Case Management or Disease Management as appropriate.
Communicates with providers to develop plan of care.
Conducts complex authorizations for beneficiaries in acute, residential treatment center, skilled nursing facilities, or long-term acute care hospitals...
Identifies and reports potential quality or fraudulent cases to Internal Audit & Corporate Compliance department or Clinical Quality Management for review.
Participates in focus group studies as requested, including the development and implementation steps.
Supports other regional hubs as needed.
Perform other duties as assigned.
Regular and reliable attendance is required.
Thorough knowledge of Utilization Management principles, Managed Care concepts, medical terminology, and medical management on-line system. Proficient with Intensity of Service and Severity of Illness indexes, InterQual Imaging Criteria, Procedural Criteria, Level of Care, and Length of Stay, Clinical Decision Support Tool, International Classification of Diseases, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Ability to meet or exceed production standards in compliance with contract