Clinical Review Nurse
Location: Atlanta Georgia
Description: Children's Healthcare of Atlanta is hiring Clinical Review Nurse right now, this position will be placed in Georgia. For detail informations about this position opportunity please give attention to these descriptions. Description
The Clinical Review Nurse participates as a member of a multidisciplinary team in completing pre-screening assessments of prospective patients. They assure comple! tion of appropriate clinical review of all applicable patients as stated in the system Utilization Management Plan and oversees Clinical Review Specialist as indicated.
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:
Provides clinical information to insurance companies as needed for completion of pre-certification process as noted in the CHOA Utilization Management Plan.
Evaluates all patients, including critical care patients for appropriateness of admission-type and setting, utilizing a combination of clinical information, screening criteria and third party information.
Assists in the development and maintenance of community standards and utilizes them appropriately as indicated in clinical review.
Reviews concurrently all inpatients, including critical care patients on a cyclic review process, determined by patient's medical condition, intensity of services being utilized, treatment plan and established review criteria. The proje! cted review date will not exceed 7 days in any circumstance.
Ensures all pertinent information is documented into various systems utilized by Children's for the UR process.
Gathers and reviews relevant medical information and based on system accepted utilization criteria documents the outcome of the UR process on the accepted current review forms and in computer systems.
Initiates and facilitates physician communications relative to the UR process when indicated.
Assists and facilitates the peer to peer review process with the Medical Director of Case Management as indicated.
Refers cases identified as peer review issues or quality issues to the appropriate personnel
Oversees Clinical Review Specialist as assigned or indicated.
Serves as a Clinical Resource to team members as necessary.
Performs other responsibilities as required.
MINIMUM QUALIFICATIONS:
Current RN license in the state of Georgia; degree in applicable clinical field or equivale! nt experience required. Bachelors of Science in Nursing degree preferred.
Three years previous experience in the health care setting is required. Pediatric experience preferred. Two years UR related experience in a hospital or insurance-related preferred.
Working knowledge of the financial aspects of third party payers and reimbursement.
Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving.
Must possess above average computer skills.
Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating within 30 days of date of hire.
Location
:
Children's Office Park
Hours Per Week
:
40
- .
If you were eligible to this position, please email us your resume, with salary requirements and a resume to Children's Healthcare of Atlanta.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Thu, 09 May 2013 00:01:11 GMT
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