Outpatient Care Nurse

Columbia, MO | 9 Months

Post Date: 06/12/2017 Job ID: WCG1JP00003801 Industry: Other

Job Position Details


2404 Forum Boulevard


Travel Time

0.000 %

Time Sheet Type


Time Sheet Frequency


Start Day of Week


Hours per Day


Hours per Week




906140 - Outpatient Care Nurse ---- Reports To (title): Varies ---- Date Last Revised: 4/21/2015 ---- FLSA Classification:: Non-Exempt ---- Job Function/Family: Health Services\Care Management ---- JOB SUMMARY ---- Oversees the utilization management activities by evaluating the necessity and efficiency of services through systematic monitoring of medical necessity and quality. while maximizing the appropriate level of care that correlates to the member's benefit plan. ---- ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities ---- Reviews and collects medical information in order to determine the medical necessity of services requested by applying specific medical criteria.---Ensures that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized.---Initiates and continues direct communication with health care providers involved with the care of the member to obtain complete and accurate information.---Identifies apporpriate clinical settings for services being requested.---Identifies and refers cases appropriate for case management.---Identifies potential quality of care issues and refers to Quality Department.---Ability to follow and apply all necessary regulatory requirements for assigned market.---Determines appropriate utilization management of services requested.---Assists with implementation of healthcare initiatives in market.---Assists in implementation of specific strategies that improve the quality and outcomes of care.---Performs other duties as assigned. ---- Additional Position Responsibilities ? Optional ---- ---- MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred ---- A High School or GED Required ---- Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred ---- 2+ years of experience in an acute clinical/surgical position(s). current experience in utilization management to include pre-authorization. utilization review. concurrent review. discharge planning. and/or skilled nursing facility reviews Required---Other Care management experience in a managed health care setting Preferred ---- Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred ---- Licensed Practical Nurse (LPN) Required---Other RN required in the state of Georgia only Required ---- Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency ---- Ability to communicate and make recommendations to upper management Intermediate---Ability to work independently Ability to work independently. handle multiple assignments and prioritize workload Intermediate---Ability to multi-task Intermediate---Ability to work in a fast paced environment with changing priorities Intermediate---Demonstrated time management and priority setting skills Intermediate---Demonstrated written communication skills Intermediate---Demonstrated interpersonal/verbal communication skills Intermediate---Ability to create. review and interpret treatment plans Intermediate---Knowledge of healthcare delivery Intermediate---Ability to effectively present information and respond to questions from families. members. and providers Intermediate---Ability to identify basic problems and procedural irregularities. collect data. establish facts. and draw valid conclusions Intermediate---Other Strong decision-making and administrative skills Intermediate ---- Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred ---- Microsoft Excel Proficient in Microsoft Office including Excel. Word and Outlook Express Intermediate Required---Microsoft Word Intermediate Required---Microsoft Outlook Intermediate Required---Healthcare Management Systems (Generic) Intermediate Required ---- Languages ---- List all that apply ---- Languages Other Languages Required/Preferred ---- ---- SCOPE ---- Level of Supervision Received: ---- A statement which describes the level of independence for this position. ---- [X] Under general supervision. proceeds alone on regular duties. referring questionable cases to supervisor. ---- Level of Supervision Exercised: ---- (Select all that apply) Positions Supervised ---- [X] Individual Contributor 1 [ ] (Please check all that apply) ---- Impact: ---- A statement which describes the impact to the company regarding contributions. decisions. recommendations or actions taken by the incumbent. ---- [X] Failure to achieve results or erroneous judgments may require the allocation of additional resources to correct and / or achieve goals. ---- Problem Complexity: ---- A statement which describes how clearly a problem is defined when presented. how much additional effort is required to understand the nature of the problem and the typical timescales for resolution. ---- [X] Provides resolution to an assortments of problems that are typically well defined. but some clarification or judgment is needed to proceed. Uses judgment within defined practices / procedures to determine appropriate action. ---- PHYSICAL DEMANDS AND WORKING CONDITIONS ---- Physical Demands ---- While performing the duties of this job. the associate is required to meet the following physical demands: ---- ---- 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_ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. ---- Working Conditions ---- While performing the duties of this job. the associate is required to meet the following working conditions: ---- Working Condition None Seldom Occasionally Frequently ---- ---- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job_ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. ---- Travel Requirements ---- END OF JOB DESCRIPTION

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