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Nurse Manager

Austin, TX 78754

Posted: 10/12/2018 Industry: Healthcare Job Number: 93922

Medical Intelligence - Lead Nurse RN

Full-time, temp to hire


Mon - Fri: 8AM to 5PM





Responsibilities


  • Conducts prospective, concurrent and retrospective utilization management


  • Assists Population Health with Case Management and Health Coaching


  • Assists with training and orientation of staff, physician consultants, health service providers and covered Individuals to specific areas within the Medical Intelligence Dept. Which includes Utilization Review; Utilization Management and Population Health


  • Develops new guidelines and workflow processes for Medical Intelligence staff on a regular basis, which includes creating technical training and documentation


  • Assist Supervisors and /or Manager with Medical Intelligence departmental reports, including quality and assurance, necessary for data analysis and workflow improvement


  • Participates in NCQA activities which includes: gathering data, assisting with analysis necessary for qualitive and quantitative reports



    Qualifications / Skills Required


  • Knowledge of Case management, Utilization Management/Utilization Review and Population Health/Coaching concepts


  • Familiarity with health care delivery system and managed care methodology


  • Familiarity with health care review criteria and ICD-10, CPT and LOS coding reference


  • Familiar with Health Plan Accreditation standards such as NCQA


  • Working knowledge of MS Office and other assigned software products


  • Preferred: Bilingual skills (Spanish). Preferable to effectively service primary member population. BSN or MSN preferred


  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions





For immediate consideration email resumes to yoany.Torres@lkjordan.Com  for an interview.


L.K. Jordan & Associates is an equal opportunity employer

#LKJ77079
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