A&G RN (Temporary)

EDUCATION: Bachelor’s degree in nursing, allied health, business, or related field preferred. Registered Nurse with current unrestricted Registered Nurse license required. Certification in Case Management may be preferred based upon designated department assignment. EXPERIENCE: Minimum two (2) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care environment preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Unrestricted USRN mainland license At least 2 years experience in utilization management / review Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes. Medicare Advantage experience an advantage Excellent written and verbal communication skills. Excellent customer service and interpersonal skills. Working knowledge of current industry Microsoft Office Suite PC applications. Ability to apply clinical criteria/guidelines for medical necessity, setting/level of care, and concurrent patient management Knowledge of current standard medical procedures/practices and their application as well as current trends and developments in medicine and nursing, alternative care settings, and levels of service Knowledge of applicable accreditation standards, and local, state, and federal regulations Appeals and grievance experience required. Strong problem-solving skills, facilitation skills, and analytical skills. Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs.

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