Nurse/Case Mgr-NoPatient Cntct position at Aerotek Scientific in Indianapolis

Aerotek Scientific is currently seeking to employ Nurse/Case Mgr-NoPatient Cntct on Tue, 22 Oct 2013 15:31:44 GMT. Summary: Responsible for collaborating with health care providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex medical issues. Major Job Responsibilities: Primary duties may include, but are not limited to: Ensures medically appropriate, high quality, cost effective care through assessing the medical...

Nurse/Case Mgr-NoPatient Cntct

Location: Indianapolis Indiana

Description: Aerotek Scientific is currently seeking to employ Nurse/Case Mgr-NoPatient Cntct right now, this position will be placed in Indiana. For detail informations about this position opportunity kindly read the description below. Summary: Responsible for collaborating with health care providers and members to promote quality member outcomes, to optimize member benefits, and to promot! e effective use of resources for more complex medical issues. Major Job Responsibilities: Primary duties may include, but are not limited to: Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Applies clinical knowledge to work with facilities and providers for care coordination. Works with medical directors in interpreting appropriateness of care and accurate claims payment.

May also manage appeals for services denied. Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance! with applicable criteria, medical policy, and member eligibil! ity, benefits, and contracts. Ensures member access to medical necessary, quality health care in a cost effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.

Collaborates with providers to assess members? needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the health care continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

May participate in or lead intradepartmental teams, projects and initiatives. Education/Experience: Requires AS/BS in nursing; 3 years acute care clinical experience; or any combination of edu! cation and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Participation in the American Association of Managed Care Nurses preferred.

Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products. Prior managed care experience preferred.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Aerotek Scientific.

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This position starts available on: Tue, 22 Oct 2013 15:31:44 GMT

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