SHIFT: Day Job
Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Ensures member access to medical necessary, quality healthcare 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 healthcare 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.
Current active unrestricted RN license to practice as a health professional within the scope of practice in the state of Louisiana and 2 years acute care clinical experience.
- Knowledge of Utilization Management/Review.
6 months managed care experience highly preferred.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- Proficient using MS Excel
“How to Find a Job” Books
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Do you have the right kind of job? How should implementation be staged? Where are you prepared to go for a job? What are the main goals of your job club? Is building culture possible with a remote team?
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Breakthrough Remote Job: Earn rewards for answering questions on products you already used and love. Products such as Microsoft, Linkedin, WordPress, Postmates, Samsung Galaxy Phones, Air BnB etc.
Earn rewards for answering questions on products you already used and love.
Products such as Microsoft, Linkedin, WordPress, Postmates, Samsung Galaxy Phones, Air BnB etc.
I earn weekly for helping WordPress customers with their problems. My job is to reply emails, chat customers and answer questions, most of which we already have answers to in our HUB and forum.
You can join too as it is available to anyone of any age worldwide.
For too long our lives have been dominated by the ‘under one roof’ Industrial Revolution model of work. That era is now over. There is no longer a reason for the daily roll call, of the need to be seen with your butt on your seat in the office. The technology to work remotely and to avoid the daily grind of commuting and meetings has finally come of age, and bestselling authors Jason Fried and David Heinemeier Hansson are the masters of making it work at tech company 37signals. Remote working is the future – and it is rushing towards us.
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