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A healthcare solutions provider is seeking a qualified nurse to participate in the Case Management Program. The ideal candidate will have an Associates Degree in Nursing and at least two years of recent nursing experience. Responsibilities include developing treatment plans and providing patient education. Candidates must possess skills in case management and relevant certifications, ensuring optimal health outcomes for patients.
Associates Degree of Nursing
Graduate from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE) or as otherwise outlined
Minimum of two (2) years recent experience within the last four (4) years in professional nursing. Under Case Manager (CM) requires minimum of two (2) years recent experience (within the last four (4) years) in professional nursing or CM. Under Utilization requires six (6) years of broad based clinical nursing experience and previous experience in UM is preferred. Must possess the necessary knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines. Must possess experience in performing prospective, concurrent, and retrospective reviews to justify medical necessity for medical care. The Contractor shall have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9 (ICD- 9), and Current Procedural Terminology-Version 4 (CPT-4) coding. Contractor personnel shall have a minimum of two (2) years of recent experience (within the last four (4) years) in nursing