Outpatient Surgery Procedure RN
Location: Metairie, Louisiana
Description: Peoples Health, Inc. is at present recruited Outpatient Surgery Procedure RN right now, this position will be presented in Louisiana. Detailed specification about this position opportunity please read the description below.
Principal Responsibilities
- Responsible for reviewing authorization requests for outpatient surgeries against InterQual criteria, CMS guidelines and Peoples Health policies.
- Responsibl e for ensuring that quality outcomes set by the department’s leadership is consistently met to maximize member experiences with service delivery.
- Coordinates the Medical Review Unit (MRU) referrals when appropriate completing all documentation.
- Validates information in request and obtains additional clinical information if necessary.
- Responsible for date entry of requests and additional documentation tracking of requests in CCMS and Macess.
- Assist in the resolution of claims pended in system.
- Responsible for issuing authorization numbers to the providers when appropriate and approved.
- Responsible for oversight and follow-up to non clinical staff for any clinical related question or issue involving an authorization.
- Reports any problem that non clinical staff has with authorizations to the supervisor within the same day of the issue.
- Clinical staff performing initial clinical review has immediate access to the Medical Directors for consultation on any clinical related question or issue under review.
- Responsible for tracking information being requested and assuring that the established time frames for medical management decisions are being adhered to.
- Log into telephone queue to accept telephone inquiries from providers or their office staff regarding notifications or authorization numbers.
- Participates in the orientation program of new staff members.
- Daily reviewing of data entry to ensure accuracy and appropriate documentation of information while reviewing daily reports.
- Participates in Medical Management Team and departmental meetings.
- Handles incoming calls from provider’s for requests for services.
- Processes and resolves items listed in individual Doc-Flo queue.
- Performs other duties as assigned within scope of required license, knowledge and experience.
Core Competencies< /b>
- Ability to multitask.
- Strong problem solving skills.
- Adaptable, flexible, team player with strong verbal and written communication skills
- Ability to effectively interact with multifaceted medical professional staff.
- Understanding of HMO and third party administration.
- Continuing education in the healthcare and managed care industry.
- Pleasant and helpful attitude toward physician, physician’s staff and Peoples Health staff.
- Strong verbal and written communication skills.
- Current Louisiana Registered Nurse license required.
- 3 years Med-Surgical clinical experience
- Understanding of Health Maintenance Organization (HMO)/Third Party Administrator (TPA) plans preferred.
- Experience in Managed Care/Insurance industry preferred.
- Continuing education in the healthcare/managed care industry preferred.
- MS Offic e preferred.
- InterQual preferred.
Supervisory Responsibility
- None
Licensure/Certification
- Current Louisiana RN license required.
Demands/Working Conditions
Must be able to lift 10-15 pounds and operate standard office equipment, computer, printer, fax and copier.
Must be able to sit for extended periods of time while using computer.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Peoples Health, Inc..
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Interested on this position, just click on the Apply button, you will be redirected to the official website
Apply Outpatient Surgery Procedure RN Here
This position will be opened on: Fri, 04 May 2018 02:04:26 GMT
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