Registered nurse ii Job at Illinois Department of Public Health (IDPH) (Manteno)

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

Staff Nurse II

As our Staff Nurse, you will be a pivotal healthcare professional, delivering co...

Location

United States , San Luis Obispo

Salary:

48.43 - 72.26 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Currently working in ICU or Cath Lab or within the last 2 years
Critical Care nursing experience required, primarily in cardiovascular nursing
Registered Nurse: CA RN
Basic Life Support - CPR BLS
Advanced Cardiac Life Support ACLS, within 90 Days

Job Responsibility

Deliver compassionate, high-quality care
Provide individualized, comprehensive care
Make critical assessments
Perform skilled procedures
Implement patient care plans
Collaborate seamlessly within an interdisciplinary team

What we offer

Health/dental/vision
FSA
Matching retirement plans
Paid time off
Tuition assistance
Adoption assistance

Fulltime

Staff Nurse II

As our Staff Nurse, you will be a pivotal healthcare professional, delivering co...

Location

United States , San Luis Obispo

Salary:

48.43 - 72.26 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Currently working in ICU or Cath Lab or within the last 2 years
Critical Care nursing experience required, primarily in cardiovascular nursing
Registered Nurse: CA RN
Basic Life Support - CPR BLS
Advanced Cardiac Life Support ACLS, within 90 Days

Job Responsibility

Deliver compassionate, high-quality care
Provide individualized, comprehensive care
Make critical assessments
Perform skilled procedures
Implement patient care plans
Collaborate seamlessly within an interdisciplinary team

What we offer

Health/dental/vision
FSA
Matching retirement plans
Paid time off
Tuition assistance
Adoption assistance

Fulltime

Registered Nurse PACU

Nurses are at the heartbeat of our organization and your time will be spent in a...

Location

United States , Colorado Springs

Salary:

33.15 - 53.04 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Associates Degree in Nursing required
Nursing Diploma or by endorsement
Graduate of an accredited School of Nursing required for new graduates, preferred for experienced RNs
One year experience preferred
Nursing skills and knowledge base specific to specialty
RN License required
Current state nursing licenses or valid RN license from a participating state in the National Licensure Compact
Previous PACU experience or strong clinical background required
Previous PACU/ICU/ED experience required

Job Responsibility

Facilitating, communicating, and collaborating with both the healthcare team, and the patient/family to identify and meet the physical, emotional, and spiritual needs of the patient
Promote the optimal health, well-being and safety of the patient through use of the nursing process and in accordance with patient care standards, guidelines and the State Nurse Practice Act
Demonstrate personal accountability for relationship-based care, organizational mission, and core values
Recover all cases both Phase I & II
RNs in pre-op/ PACU are responsible for pre op calls, PATs, transports in addition to the clinical aspects of pre-op and PACU care

What we offer

Relocation assistance up to $8,000
Certification pay
Clinical Career Ladder
Benefits package may include medical, prescription drug, dental, vision plans, life insurance, paid time off, tuition assistance, adoption assistance, retirement plan benefit(s) including, but not limited to, 401(k), 403(b)

Parttime

Rn per diem ii

Work within the nursing process to provide direct nursing care to assigned patie...

Location

United States , Rio Rancho

Salary:

47.38 USD / Hour

UNM Hospitals

Expiration Date

Until further notice

Requirements

Program Graduate
Nationally Accredited Nursing Graduate
1 year directly related experience
CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days
RN in NM or as allowed by reciprocal agreement by NM

Job Responsibility

Work within the nursing process to provide direct nursing care to assigned patients consistent with clinical specialty
Serve as a role model to promote a positive work environment and quality patient care
Ensure adherence to Hospitals and departmental policies and procedures
Minimum work requirement for RN Per Diem II is four shifts per schedule
Two weekend shifts per schedule and one summer and one winter holiday are required
Deliver safe direct care to an assigned group of patients as required
Work within Hospitals, Nursing division and departmental policies
Work in collaboration with the healthcare team, implement and document individualized care plans incorporating age specific considerations, including discharge planning and patient/family teaching
Assist with special tests and procedures, ensure proper consent has been obtained
Participate in orientation

What we offer

Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials

Parttime

New

Registered Nurse II - Sedation

The Registered Nurse (RN) is accountable for providing competent nursing care. R...

Location

United States , Madera

Salary:

42.50 - 69.90 USD / Hour

Valley Children's Healthcare

Expiration Date

Until further notice

Requirements

Program Accredited nursing program (required)
College Degree - 4 year Nursing (preferred)
RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)
BLS - Basic Life Support - AHA - American Heart Association within 30 days of hire or transfer into position (required)
ACLS - Advanced Cardiac Life Support - AHA - American Heart Association Cardiac Cath Lab, Endo, Recovery, and Sedation within 12 months of hire or transfer into position (required)
PALS - Pediatric Advanced Life Support - AHA - American Heart Association Cardiac Cath Lab, Endo, Recovery, and Sedation within 12 months of hire or transfer into position (required)
Experience to correlate with Clinical Advancement Program (required)
Bilingual Skills Preferred

Job Responsibility

Providing competent nursing care
Coordination of the patient's plan of care through assessment, planning, implementation, and evaluation of nursing interventions that lead to established outcomes

Parttime

New

Clinical Informatics Registered Nurse II

The Clinical Informaticist (CI) is a clinical leader who serves as the liaison f...

Location

United States , Madera

Salary:

53.00 - 82.00 USD / Hour

Valley Children's Healthcare

Expiration Date

Until further notice

Requirements

College Degree - 4 year Nursing (required)
BLS - Basic Life Support - AHA - American Heart Association within 30 days of hire or transfer into position (required)
RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing California license (required)
EPIC Certification 1 - EPIC Epic Certification necessary to support area of specialty. within 90 days of hire or transfer into position (required)
Minimum four (4) years Clinical experience (required)
Minimum two (2) years Experience and demonstrated competency with the current electronic documentation system. (required)
Ability to work with colleagues in a positive way to help reinforce changes in workflows supporting the intended use of the electronic system and avoiding system work-arounds.

Job Responsibility

Serves as the liaison for health IT efforts supporting clinical workflows and associated information systems requirements
Responsible for planning, coordinating, and monitoring the analysis, design, implementation, evaluation, and maintenance of assigned health informatics applications and projects
Partners with Nursing, clinical staff, providers, Information Technology Services (ITS), Business/Administrative Services, Project Management (OPMO/ITPMO), and other entities to successfully design, educate, implement, adopt, and sustain interoperability within clinical and non-clinical information systems
Facilitates informatics-based projects using ongoing process improvement and change management techniques
Responsible for identifying opportunities to reduce risk, improve workflows and care delivery, and diligently facilitating evidence-based, best practice and scope advocacy throughout projects, education, and technology
Facilitates, designs, development, collaboration, implementation, support, and evaluation of clinical education programs and initiatives related to Clinical Informatics and the Electronic Medical Record (EMR) in alignment with the organizational strategic plan, regulatory requirements, and clinical outcomes.

Fulltime