RN will work on Infusion Therapy Team. Candidates would have outpatient experience, chemotherapy, office, or infusion center. Best would be prior authorization experience
Top Skills Should You Possess:
- RN
- Candidates would have outpatient experience, chemotherapy, office, or infusion center. Best would be prior authorization experience
- Evaluate a member’s clinical condition through the review of medical records
- Directly interacts with providers to obtain additional clinical information
- Utilizes resources such as InterQual, Care Management Policy, Medical Policy, and Electronic Desk References to determine the medical appropriateness of the proposed plan.
- Contacts servicing providers regarding treatment plans/plan of care and clarifies medical need for services.
- Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient admissions or continued stay, clarifying medical information with provider if needed.
- Identifies and refers cases in which the plan of care/services are not meeting established criteria to the Medical Director for further evaluation determination.
- Performs early identification of members to evaluate discharge planning needs.
- Collaborates with case management staff or physicians to determine alternative settings at times and provide support to facilitate discharge to the most appropriate setting.
- Reports on potential utilization issues or trends to designated manager and recommendations for improvement
- Appropriately refers cases to the Quality Management Department and/or Care Management and Coordination Manager when indicated to include delays in care.
- Appropriately refers cases to Case and Disease Management.
- Ensures request is covered within the member’s benefit plan.
- Ensures utilization decisions are compliant with state, federal and accreditation regulations.
- Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
- Ensures that all key functions are documented via Care Management and Coordination Policy.
- Maintains the integrity of the system information by timely, accurate data entry.
- Performs additional duties assigned.
- Registered Nurse/BSN preferred
- Minimum of three (3) years of acute care clinical experience in a hospital or other health care setting.
- Candidates would have outpatient experience, chemotherapy, office, or infusion center. Best would be prior authorization experience
- Weekends and holidays off
- Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities.
- Direct deposit & weekly epayroll
Recruiter: Kim Myers
Estimated Min Rate: $45.00
Estimated Max Rate: $45.00
What’s In It for You?
We welcome you to be a part of the largest and legendary global staffing companies to meet your career aspirations. Yoh’s network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh’s extensive talent community that will provide you with access to Yoh’s vast network of opportunities and gain access to this exclusive opportunity available to you. Benefit eligibility is in accordance with applicable laws and client requirements. Benefits include:
- Medical, Prescription, Dental & Vision Benefits (for employees working 20+ hours per week)
- Health Savings Account (HSA) (for employees working 20+ hours per week)
- Life & Disability Insurance (for employees working 20+ hours per week)
- MetLife Voluntary Benefits
- Employee Assistance Program (EAP)
- 401K Retirement Savings Plan
- Direct Deposit & weekly epayroll
- Referral Bonus Programs
- Certification and training opportunities
Note: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Visit https://www.yoh.com/applicants-with-disabilities to contact us if you are an individual with a disability and require accommodation in the application process.
For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.
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