Senior Registered Nurse

Integrated Resources Inc.; Des Moines (IA); On-site; USD 65,000 - 85,000; Full time

Job summary

A leading staffing firm is seeking a Clinical Care Reviewer to conduct thorough medical necessity reviews under the supervision of a unit supervisor. The role requires a Registered Nurse with at least 3 years of experience in a clinical setting, focusing on ensuring that appropriate services are approved. The ideal candidate will be self-directed with excellent communication and decision-making skills, dedicated to patient advocacy, and able to work independently.

Qualifications

• 3+ years’ experience with Community based Waiver in a clinical setting.
• Ability to work independently and prioritize tasks effectively.
• Obtains continuing education required for professional licensure.

Responsibilities

• Reviews provider requests for inpatient and outpatient services.
• Uses clinical judgment for medical necessity reviews.
• Maintains knowledge of relevant laws, regulations, and policies.

Skills

Communication

Decision Making

Time Management

Problem Solving

Advocacy

Education

Registered Nurse

Job description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Job Summary
The primary purpose of the job is to:
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse’s discretion to pend requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit’s business and uses clinical judgment in their application.

Qualifications

Short Description: Clinical Care Reviewer - IA
Complete Description: 3 or more years’ experience with Community based Waiver in a related clinical setting.
Registered Nurse
Excellent oral and written communication skills.
Ability to identify problems and recommend solutions.
Self-directed/Ability to work independently.
Excellent decision making skills.
Excellent time management skills, prioritizing work and meeting timelines.
Ability to advocate for member/member family needs.
Dedicated to meeting the expectations and requirements of internal and external customers.
Obtains continuing education required to maintain professional licensure.
Ability to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer).

Additional Information

Life Science Recruiter

Integrated Resources, Inc.

DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549