Data Coordinator – Trauma, Burn, and Injury Prevention
Children's Mercy Kansas City
RN Case Manager, Health Services
Sharp HealthCare
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $56 - $88 per hour
Job Level
JuniorMid-Level
About the role
- Perform acute and ambulatory case management, utilization management and claims review activities
- Authorization of medically necessary patient care services and referrals using Sharp Health Plan Medical Policies and Milliman Care Guidelines
- Ensure denial letters include individualized denial reasons and alternate plan of care
- Coordinate care between physicians, specialists, vendors, community services, and caregivers
- Develop care plans with patient and family physician for acute or community based services
- Maintain detailed, accurate and timely data files on each client
- Provide prospective, concurrent, retrospective and claims review and care management services
- Conduct telephonic or onsite assessments, care planning, arranging and coordinating services, and monitoring
- Ensure provider compliance with plan standards and guidelines
- Educate clients, providers, medical groups and hospitals regarding plan benefits and resources
- Serve as trainer/mentor for new case managers during first 90 days
- Participate in testing UM and CM applications and special projects
- Develop and maintain monthly utilization and case management reports and analysis of statistics
Requirements
- Graduate of an NLN-accredited School of Nursing
- California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED
- 2 Years Medical or surgical nursing
- Preferred: Bachelor's Degree in Nursing
- Preferred: 3 Years Utilization, quality, and/or case management experience in managed care setting
- Ability to work on own without supervision
- Excellent written and verbal communication skills
- Organizational, analytical and problem solving skills
- Knowledge of current standards of practice and available health resources within the community
