Care Management Coordinator Rn Nicu - Part Time

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

Biweekly schedule:

Week #1: works Mon.-Wed. (22.5hrs)

Week #2: works Thurs.-Fri. (15hrs)

Job Summary

The Care Management Coordinator primary responsibility is to evaluate a member’s clinical condition through the review of medical records (including medical history and treatment records) to determine the medical necessity for patient’s services based on advanced knowledge and independent analysis of those medical records and application of appropriate medical necessity criteria. If necessary, the Care Management Coordinator directly interact with providers to obtain additional clinical information. The Care Management Coordinator has the authority to commit the company financially by independently authorizing services determined to be medically necessary based on their personal review. For those cases that do not meet established criteria, the Care Management Coordinator provides relevant information regarding members medical condition to the Medical Director for their further review and evaluation. The Care Management Coordinator has the authority to approve but cannot deny the care for patients. The Care Management Coordinator is also responsible for maintaining regulatory compliance with federal, state and accreditation regulations. Additionally, the Care Management Coordinator acts a patient advocate and a resource for members when accessing and navigating the health care system.

Key Responsibilities

§ Note:InterQual - It is the policy of the Medical Affairs Utilization Management (UM) Department to use InterQual (IQ) criteria for the case review process when required. IQ criteria are objective clinical statements that assist in determining the medical appropriateness of a proposed intervention which is a combination of evidence-based standards of care, current practices, and consensus from licensed specialists and/or primary care physicians. IQ criteria are used as a screening tool to support a clinical rationale for decision making.

Qualifications

• Exceptional communication, problem solving, and interpersonal skills.
• Action oriented with strong ability to set priorities and obtain results.
• Team Player - builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy.
• Open to change, comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable.
• Embrace the diversity of our workforce and show respect for our colleagues internally and externally.
• Excellent organizational planning and prioritizing skills.
• Ability to effectively utilize time management.
• Oriented in current trends of medical practice.

• Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs. Ability to learn new systems as technology advances.