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RN - Utilization Review Nurse/Case Manager Nurse (Telehealth)
| Hours | Full-time, Part-time |
|---|---|
| Location | Portland, Oregon 97204 Portland, Oregon |
About this job
Multiple RN openings for Utilization Review Nurses & Case Managers for a growing healthcare company located in Portland, Oregon.
We are also seeking candidates interested in leadership opportunities for supervisor, management, and director level openings.
All positions are full-time, long-term, and offer competitive compensation and benefits package including (medical/dental/vision, 401k, education reimbursement, bonuses and much more!)
Utilization Review Nurse
- Perform review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to medical Directors for review depending on case findings
- Collaborate with various staff within provider networks and discharge planning team electronically and telephonically
- Educate providers on utilization and medical management processes
- Provide clinical knowledge and act as a clinical resource to non-clinical team staff
- Enter and maintain pertinent clinical information in various medical management systems
Qualifications:
- Must have active Oregon or Washington RN license (Will consider candidates who are willing to relocate for this opportunity)
- 2+ years of clinical nursing experience in a clinical, acute care, or community setting.
- Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred but not required.
- Previous case management/utilization review experience is a plus, but not required.
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio- economic needs of clients
- Provide patient and provider education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
- Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred.
- 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.
- Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
- OR or WA RN license is required.
Director, Case Management
- Direct the overall operational leadership of case management functions and staff
- Perform and oversee needs analysis and planning
- Work with executive leadership to ensure targets are met for the annual operating plan/financial management
- Ensure compliance with Corporate, State and NCQA standards
- Develop and implement methods, policies and procedures to improve the departments efficiency and effectiveness
Qualifications:
- Bachelor's degree in Nursing or related field.
- At least 5 years of work experience in managed care and acute care settings with complex case management.
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
If you are interested in any of these opportunities, please apply to this posting and we will reach out to you for an interview.
About Aerotek:
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.
Aerotek is acting as an Employment Agency in relation to this vacancy.