ColumbiaMORecruiter
the smart solution for Columbia jobs

Inpatient Care Nurse RN - Columbia, MO, Omaha, NE or Lincoln, NE based

Company: WellCare
Location: Columbia
Posted on: April 16, 2019

Job Description:

Works collaboratively with supervisors, providers, community resources, and facilities to establish and implement processes to support delivery of effective utilization management. Coordinates assignments to manage daily census. Acts as clinical specialist and utilization management subject matter expert for complex situations. Provides mentoring and training to other inpatient utilization review nurses. Champions compliance requirements.

DEPARTMENT: Health Services - Inpatient

REPORTS TO: Supervisor, Clinical Care

Essential Functions:


  • Telephonically reviews medical information in order to determine the medical necessity of continued stay according to review standards. Determines whether treatments are consistent with member's diagnosis and appropriate level of care.

  • Uses critical thinking to determine if treatments are consistent with member's diagnosis and clinical needs. Ensures services provided are within benefit plan and that appropriate contracted providers are utilized.

  • Identifies needed information. Works with providers to obtain the information pertinent to evaluating treatment plan, medical necessity, appropriateness of care, timely progression of services and appropriate application of available benefits.

  • Initiates interactions with providers regarding anticipated progression of care and transitions across treatment settings. Facilitates referrals for follow up providers and support services.

  • Evaluates clinical information to identify and present cases during rounds. This includes identification of members at high risk for complicated medical treatment plans, readmissions potential, and admissions for potentially avoidable conditions.

  • Prepares cases for review by medical director when condition or treatment plan varies from established guidelines.

  • Documents clinical updates, authorizations, and referrals in the health plan care management system adhering to health plan documentation standards.

  • Provides members and/or treating providers with resources to enhance their ability to access services.

  • Performs other duties as assigned.


    Candidate Education:



    • Required a High School or GED

    • Preferred a Bachelor's Degree in a related field


      Candidate Experience:



      • Required 2 years of experience in Acute medical hospital experience (medical/surgical, emergency room, orthopedic, neurological care experience

      • Preferred 2 years of experience in UM, CCM, Clinical Criteria, or other nursing specialty certification

      • Preferred 2 years of experience in discharge planning


        Candidate Skills:



        • Intermediate ability to work independently

        • Intermediate ability to multi-task

        • Intermediate demonstrated time management and priority setting skills

        • Intermediate demonstrated interpersonal/verbal communication skills

        • Intermediate demonstrated written communication skills

        • Intermediate ability to create, review and interpret treatment plans

        • Intermediate demonstrated problem solving skills

        • Intermediate knowledge of healthcare delivery

        • Intermediate ability to effectively present information and respond to questions from families, members, and providers

        • Intermediate ability to effectively present information and respond to questions from peers and management


          Licenses and Certifications:

          A license in one of the following is required:



          • Required Registered Nurse (RN)


            Technical Skills:



            • Required beginner Microsoft Excel

            • Required intermediate Microsoft Word

            • Required intermediate Microsoft Outlook

            • Required intermediate Healthcare Management Systems (Generic)

              About us

              Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: WellCare, Columbia , Inpatient Care Nurse RN - Columbia, MO, Omaha, NE or Lincoln, NE based, Healthcare , Columbia, Missouri

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


ORTHO Registered Nurse
Description: Supplemental Health Care is seeking an Orthopedic Med Surg Registered Nurse with recent RN hospital experience to join one of our trusted partnering hospitals in Columbia, MO. br br Job Title: Orthopedic (more...)
Company: Supplemental Health Care
Location: Columbia
Posted on: 04/20/2019

Healthcare home office
Description: The nations leading healthcare benefits company is looking for driven, self sufficient workers in
Company: Health Options 16
Location: Chesterfield
Posted on: 04/20/2019

Speech Language Pathologist - School SLP
Description: Nationwide Travel Locum Therapist Jobs Speech Language Pathologist for nationwide school assignments Are you looking for a new therapist job Would you like to spend the season somewhere you've never (more...)
Company: HealthCare Travelers
Location: Chesterfield
Posted on: 04/20/2019


ICU RN
Description: Registered Nurse - Intensive Care Unit Position: Registered Nurse Specialty: Intensive Care Unit 13 week Intensive Care Unit Registered Nurse travel assignment Hospital in Columbia, MO is looking for (more...)
Company: Fusion Medical Staffing
Location: Columbia
Posted on: 04/20/2019

Travel RN Seasonal Jobs - HealthCare Travelers
Description: Travel Nurses Needed - All RN Specialties Vermont Travel Nursing Assignments Hospitals are posting their seasonal staffing needs Would you like to spend the fall / winter somewhere great The Hospitals (more...)
Company: HealthCare Travelers
Location: Saint Charles
Posted on: 04/20/2019

Operating Room Registered Nurse
Description: Supplemental Health Care has partnered with a leading hospital in Columbia Missouri offering an excellent contract opportunity
Company: Supplemental Health Care
Location: Columbia
Posted on: 04/20/2019

Healthcare Position - Homebased
Description: Our growing health benefits company is seeking at home representatives. Must be self-motivated and driven. We provide you
Company: Medical Company
Location: Saint Charles
Posted on: 04/20/2019

RN Travel Nurse - ICU, ER, L&D, OR, PACU
Description: Travel Nurses Needed - All RN Specialties Arkansas Travel Assignments Looking for a travel assignment in the state of Arkansas You are in the right place, the HCEN Network of staffing agencies have numerous (more...)
Company: HealthCare Travelers
Location: Chesterfield
Posted on: 04/20/2019

Cath Lab Registered Nurse
Description: Supplemental Health Care is a nationally recognized healthcare staffing provider partnering with a hospital in Columbia, MO to provide a Local Cardiac Cath Lab Registered Nurse. br br For immediate (more...)
Company: Supplemental Health Care
Location: Columbia
Posted on: 04/20/2019

Occupational Therapist Travel & Locum - School OT
Description: Occupational Therapist are one of the specialties that have the most difference between staffing agencies in job / travel assignment locations and pay rates Must have 2 yrs of Relevant Experience Current (more...)
Company: HealthCare Travelers
Location: Chesterfield
Posted on: 04/20/2019

Log In or Create An Account

Get the latest Missouri jobs by following @recnetMO on Twitter!

Columbia RSS job feeds