Utilization Review Nurse-Remote

Tenet Healthcare Corporation Frisco , TX 75034

Posted 2 months ago

EDUCATION AND/OREXPERIENCE REQUIREMENTS

Bachelordegree in a health related field, five (5) years of UM/CM experience, and CCMpreferred. Registered Nurse license andthree to five (3-5) years of diverse clinical experience required.

COMPETENCY PREREQUISITES

  • Currentactive professional license in the state of residence

  • Eligibilityfor unrestricted professional licenses in all states

  • Competencyin Microsoft Word

  • Competencyin using email, attachments

  • Excellentverbal communication skills with the ability to communicate with participantsand communicate professionally with individuals who serve in a variety offunctions, i.e. physicians, account managers, brokers, customer service staff,IMMS executive management, other IMMS Medical Management nurses, hospitalutilization review nurses, etc.

  • Excellentwritten communication skills with the ability to write in a professional,business manner

  • Abilityto analyze and resolve complex problems

  • Excellentorganizational and prioritization skills

  • Excellenttime management skills

  • Abilityand willingness to function as part of a team

  • Abilityand willingness to function independently

  • Flexibilityand willingness to change

  • Understandingof IMMS holistic approach to medical management

  • Understandingof the client's (customer's) perspective and needs

  • Understandingof legislative acts, such as the ADA

PERFORMANCE

  • Complieswith laws and regulations that govern the medical management services.

  • Adheresto IMMS Policies and Procedures

  • FollowsPolicies and Procedures for Personal Health Management and utilizationmanagement

  • Understandsof IMMS holistic approach to medical management

  • Understandsthe client's (customer's) perspective and needs

  • Adheresto of the CMSA Standards of Practice

  • Advocatesfor participant to obtain quality health care

  • Identifiesliability issues associated with the performance of medical management

  • Adheresto CMSA Standards of Practice and Professional Code of Ethics

Nursing


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Remote Telehealth Nurse Educator

Amerisourcebergen Corporation - Corporate

Posted 1 week ago

VIEW JOBS 4/17/2019 12:00:00 AM 2019-07-16T00:00 Under general direction of the Senior Nurse Manager or Nurse Manager, responsible for providing clinical product and diagnosis related information and services to physicians, nurses, health professionals and patients. * Provide consumer support in a call center environment for patients receiving treatment within a designated specialty. * Risk assess patient for compliance and adherence to treatment regimen * Identify barriers to care * Provide information about disease process * Provide emotional support to patient and family members * Accepts inbound calls and makes outbound calls to enrolled patients * Receives notification through, but not limited to: web portal, live chat, patient assistance program, fax enrollment form, electronic enrollment form or phone; calls patient to provide information about the product, program, send out information kits if needed and management advise for any side effects * Enter all consumer activities accurately in clinical data base * Intakes and reports adverse events as directed * Must be able to work a flexible schedule and have flexibility for changing program needs * Performs related duties as assigned * Must possess a current license issued by a state or states or jurisdiction(s) within the United States, and be unrestricted in any state. * Graduation from an accredited nursing program * Experience with and/or potential to provide high quality customer service * 5 years of experience within a designated specialty such as oncology, neurology, medical information/pharmacovigilance, behavioral health * Must be able to work 10:30 am - 7 pm CST * Graduation from an accredited nursing program Amerisourcebergen Corporation - Corporate Frisco TX

Utilization Review Nurse-Remote

Tenet Healthcare Corporation