RN Clinical Coordinator Intermediate Care Job at American Nursing Care (Colorado Springs)

RN Clinical Coordinator Intermediate Care

Embrace your purpose and unique talents now, and put them to work. We value indi...

Location

United States , Colorado Springs

Salary:

37.31 - 59.51 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Associates Degree in Nursing (Nursing Diploma or by endorsement) required
BSN, preferred
RN License to practice in state of employment as applicable, required
Nursing Specialty Certification, preferred
Minimum of 1 year of direct clinical experience as a Registered Nurse
Physical Requirements: Medium Work - (Exert up to 50lbs force occasionally, and/or up to 20lbs frequently, and/or up to 10lbs constantly)

Job Responsibility

Actively support the department director/manager by coordinating clinical and department activities for the unit
Serve as a clinical nurse and resource to the staff, authorize work procedures and assign duties, shift charge
Demonstrating strong clinical judgment and ensuring high-quality care delivery to each patient
Acting as a vital link between physicians and the patient care team to facilitate seamless communication and collaboration
Maintaining communication and promote cooperation with unit staff and other departments
Provides input and recommendations to the director/manager on coaching, mentoring and performance management of associates
Assumes responsibility and accountability for 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
Act as a professional role model for all staff by demonstrating ethical/legal/professional nursing
Promotes 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
Actively serves on unit as a registered nurse and may take patient assignments based on unit and patient needs and acuity

What we offer

Qualified external applicants may be eligible for a $20,000 sign-on bonus
Depending on your location, you may be eligible for up to $8,000 in relocation assistance
health/dental/vision, FSA, matching retirement plans, paid time off, tuition assistance, adoption assistance, and more
full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually
401(k), 403(b), and other defined benefits offerings

Fulltime

Rn Med Policy Development/Research Specialist (Um Experience)

Perform medical technology research to support the Medical Director Staff and Me...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in clinical field of practice, health insurance, or other health care related field (All Levels)
1 year(s) of experience in medical policy and technology research field (Applies to Level 2)
2 year(s) of experience in medical policy and technology research field (Applies to Level 3)
Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program (Applies to All Levels)
Active, current, and unrestricted license to practice in the State of Arizona as a health professional, including RN, LPN, LPT, LBSW, LMSW, or LCSW. (Applies to All Levels)
Intermediate PC proficiency
Intermediate Adobe PDF Standard proficiency
Intermediate word processing, spreadsheet and presentation software proficiency (Applies to All Levels)
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform medical technology research to support the Medical Director Staff and Medical Policy Panel with decisions to ensure that medical policies are consistent with the standards of accepted medical practice in the community
Perform medical technology research related to coverage guidelines and new technology and provide evaluation and summarization to Medical Director Staff and/or Medical Policy Panel
Perform medical technology research as requested by other areas of BCBSAZ thru the Medical Policy Referral Form
Develop and revise coverage guidelines and criteria as requested by management, Medical Director staff or Medical Policy Panel
Communicate medical policy information in protocol format to all areas of BCBSAZ requiring this information
Participate as a contributing member on the Medical Policy Panel providing medical policy issues for discussion and, as required, on the Clinical Coding Governance Committee (CCGC)
Maintain a thorough knowledge of all BCBSAZ medical coverage guidelines and other policies, such as BCBS Association Medical Policy Reference Manual, MCG care guidelines and/or Change Healthcare InterQual, and eviCore criteria
From the direction of management, Medical Director staff or Medical Policy Panel, facilitate external consultant reviews concerning a coverage guideline or new technology
Communicate medical policy information in protocol format to healthcare providers upon request
With moderate assistance and review by management, perform basic level of code review

Fulltime

Integrated Care Manager - Remote AZ

Location

United States of America , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

Integrated Care Manager

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

Senior Manager Clinical Eligibility

The Senior Mgr of Clinical Eligibility will have knowledge of the current assess...

Location

United States , New York

Salary:

Not provided

Healthfirst

Expiration Date

Until further notice

Requirements

NYS licensed RN
Knowledgeable of state and federal regulations including experience interpreting those regulations as it pertains to different programs
Excellent interpersonal skills, especially relating well with a frail adult population, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations while still achieving department goals and objectives
Understanding of and sensitivity to cultural differences and needs of the community are essential with a diverse and multi-cultural work environment and community of members such as Spanish, Chinese, Russian, Creole and Korean
Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese
Bachelor's degree
Intermediate Microsoft Word, Excel, Outlook, Powerpoint, Access, Adobe, Visio, and project skills
Proficient navigating internet browsers, computer hardware, and multiple applications simultaneously, using encryption security tools, multiple electronic PHI databases, working in with a VPN and Citrix platform and very accurate typing skills
Demonstrated professionalism and leadership skills along with the ability to develop, direct, and support staff
Experience in home care environment, acute, sub-acute or long term care (LTC) setting or managed-long term care (MLTCP)

Job Responsibility

Participates in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals
Meets regularly with direct reports to review goals, trends, and performance measures and to facilitate change
Participates in continued staff development to improve the decision-making process
Provides administrative on-call coverage to troubleshoot and coordinate the delivery of care and services to members
Manages Assessment Managers to ensure timely assessments and targeted interventions to meet a member's changing condition(s)
Supports the care management teams to ensure effective care management and oversight of home vendor services
Supervises and directs the completion of assessments at established intervals to coincide with care plan development/revision and ensures early identification and action to address emergent issues
Assists members and prospective members with assessment and clinical eligibility questions
Coordinates with contract services to ensure understanding of the MLTC model, FIDA, MAP, and MMCP and cooperation with the assessment process
Ensures coordination with home health, nursing, and social work care as it relates to the care plan

What we offer

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

Fulltime

Integrated Care Manager

Responsible for promoting continuity of care through a collaborative process tha...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN.
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC.)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan.
Answer a diverse and high volume of health insurance related customer calls on a daily basis.
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements.
Maintain complete and accurate records per department policy.
Demonstrate ability to apply plan policies and procedures effectively.

Fulltime

Initial Clinical Reviewer

Responsible for identifying, researching, processing, resolving, and responding ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 years of experience in clinical field of practice, health insurance, or other health care related field
Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Strong current clinical knowledge
Practice interpersonal and active listening skills to achieve customer satisfaction
Compose a variety of business correspondence
Interpret and translate policies, procedures, programs and guidelines

Job Responsibility

Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person
Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit 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
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
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
When indicated to assist with team/project functions: Collaborate with team to distribute workload/work tasks
Monitor and report team tasks

Fulltime

Manager - Integrated Care

Responsible for developing and managing the day to day processes required to pro...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 years of experience in full-time equivalent of direct clinical care to the consumer
1 year of experience in a supervisory role
Associate’s Degree in general field of study or Post High School Nursing Diploma
or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D.
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse (RN)
or independent license in the behavioral health profession such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.)
Once they have directly supervised the integrated care process within (3) years with the organization, hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)
Intermediate skill in use of office equipment including copier, fax machine, scanner and telephones
Intermediate PC proficiency

Job Responsibility

Manage and oversee all staff activities related to the development and delivery of health improvement/management programs for members with both complex and chronic health care needs
Promotes the integrated, whole-person approach to a continuum of care
Provide oversight and recommendations on the cases being managed through any of the programs
Direct all activities required to maintain accreditation for Case and Utilization Management
Responsible for monitoring and reporting department and program performance measures including IRR
Evaluate, interpret, and negotiate applicable benefit and regulatory requirements
Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person
Responsible for the review, update and accuracy of documentation, computer files, policies and procedures related to the departmental goals and objectives
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and implement operational changes and process improvement
Keep status of unit current in accordance with service standards, systems, procedures, forms and manuals through staff meetings, verbal and written communications

Fulltime

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RN Clinical Coordinator Intermediate Care

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