Quality Resource Nurse Specialist
Location: Tampa Florida
Description: CareCentrix is currently interviewing Quality Resource Nurse Specialist right now, this occupation will be placed in Florida. Detailed specification about this occupation opportunity please read the description below. POSITION SUMMARY
This position functions as the primary contact for utilization, clinical questions and concerns from all Regional Care Center (RCC) associates. Serves a! s a resource for the utilization program and guideline implementation. Manages clinical data collection, analysis and reporting. Supports RCC operations and RCC management team with clinical feedback and utilization training. Works in conjunction with the Clinical Management Team to support utilization management goals and objectives. Collaborates as indicated with the referral source, health plan case managers and physicians to resolve issues pertaining to complex clinical cases. Works under general supervision.
PRIMARY RESPONSIBILITIES
Functions as the resource to all RCC associates. Supports the management team with training, tools and clinical oversight for all departments.
Works with National Director of Clinical Management to support clinical and utilization management goals and objectives.Works with the National Director of Clinical Management to implement best practices for utilization and authorization management of selected home care ser! vices. Works collaboratively with others as needed.
C! ompletes designated reporting analysis requiring clinical expertise for adherence to CareCentrix operational processes.
Audits cases as indicated to monitor and promote compliance with payer criteria and utilization guidelines, clinical operation policies and CareCentrix policies. Works with the Director of Clinical Management and Director of Quality Improvement to track. National Director to promote compliance with CareCentrix policies, legal requirements and regulatory mandates.
Attends/participates in staff development programs and obtains continuing education as required by company policy and licensing bodies. Interacts with referral sources to facilitate communications, answer questions and resolve problems.
Required Skills
This position requires excellent writing, organization and communication skills. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed ! below are representative of the knowledge, skill and/or ability required
Required Experience
Registered Nurse license in the state(s) of practice without restrictions is required. Minimum of eight years experience with thorough knowledge of healthcare delivery systems and managed care regulations, utilization management, case management, process improvement, and re-engineering processes, contract terms/stipulations, capitation requirements and government regulations also required. Previous management and leadership experience strongly desired. Competent and Experienced with Utilization Management and URAC standards.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to CareCentrix.
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This occupation starts available on: Fri, 29 Mar 2013 07:49:32 GMT