the smart solution for Columbia jobs

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

Company: WellCare
Location: Columbia
Posted on: May 18, 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. 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, Healthcare , Columbia, Missouri

Click here to apply!

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

I'm looking for
in category

Other Healthcare Jobs

Infectious Disease Physician (Physician #)
Description: Job Description Requirements br Infectious Disease Physician in Missouri br StartDate: 08/01/2019Pay Rate: .00 br br Take advantage of these rare opportunities to work with one of the nation's (more...)
Company: Merritt Hawkins
Location: Columbia
Posted on: 05/26/2019

Pediatric Neurology opening in MO (Physician #)
Description: Pediatric Neurology opening at Academic Institute in Missouri Located in Columbia, MO Service area of 200,000 people 1.5
Company: Archway Physician Recruitment
Location: Columbia
Posted on: 05/26/2019

RN - Interventional Radiology
Description: RN - Interventional Radiology Fulfill your calling at SSM Health. At SSM Health we know that being a nurse is more than a career, it is a calling. As an SSM Health nurse, you have responsibility to carry (more...)
Company: SSM Health St. Joseph Hospital - St. Charles
Location: Saint Charles
Posted on: 05/26/2019

Dental Hygienist
Description: Employer is a leading, multi-specialty group practice based in St. Louis, Missouri. Our practice began in the 1950 s as the General Practice Residency in Dentistry program at what is now the Barnes-Jewish (more...)
Company: Premier Dental Partners
Location: Saint Charles
Posted on: 05/26/2019

Allergy / Immunology Physician Allergist - Physicians Only Apply - Perm
Description: A Allergy / Immunology Physician Allergist practice is seeking a qualified physician for Columbia, MO. This and other physician jobs brought to you by ExactMD. Medical Doctors Only
Company: The Medicus Firm
Location: Columbia
Posted on: 05/26/2019

Nuclear Medicine Supervisor
Description: Shift: Days with Call and Holidays Required Department: Nuclear Medicine Salary Range: 31.86 - 49.53 Job Summary: Supervise the staff of a specific Radiology area, providing quality patient treatment. (more...)
Company: MU Health Care
Location: Columbia
Posted on: 05/26/2019

RN House Administrator-PT
Description: Role Purpose: The House Administrator is responsible for the administrative and functional operations of the Health Center on a given shift. These functions are carried out according to the philosophy, (more...)
Company: SSM Health St. Mary's Hospital - Jefferson City
Location: Jefferson City
Posted on: 05/26/2019

Registered Nurse (RN) Telemetry $20,000 Sign On Bonus
Description: Registered Nurse RN Telemetry 20,000 Sign On Bonus Join our exceptional team and earn up to 20,000 in Sign On Bonus At SSM Health we know that being a nurse is more than a career, it is a calling. (more...)
Company: SSM Health St. Joseph Hospital - St. Charles
Location: Saint Charles
Posted on: 05/26/2019

Permanent Outpatient FP Opening in Missouri (Physician #)
Description: Permanent Family Practice job opportunity in central Missouri for BE/BC physician. br Located in a
Company: VeloSource
Location: Columbia
Posted on: 05/26/2019

Start a new career in the Health Care Industry!
Description: Elite dental and health benefits company is seeking motivated people to build their own business. We are a service based company. We do not
Company: Ameriplan
Location: Jefferson City
Posted on: 05/26/2019

Log In or Create An Account

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

Columbia RSS job feeds