Are you passionate about patient care? Do you enjoy working and resolving issues? If you thrive in a dynamic environment and have a real passion for helping people, we'd love to hear from you.
As a Continuity of Care Nurse you will provide organizational support in utilization management, and patient care coordination using established care criteria. You will process referral authorizations requests from physicians and vendors. You will be responsible for carrying out the management of medical episodes across the health continuum, including coordination of patient, family, doctor, hospital and health plans, documenting in the electronic record and certain products. You may be responsible for implementation of protocols and programs to assist and educate the network physician offices, insurance vendors and hospital departments.
Working hours: 8:00 AM - 5:00 PM
- In processing referrals, you will utilize health plan medical guidelines, DOFR, and within insurance benefit structure of the patient policy
- Adhere to Federal, State and health plan regulatory guidelines
- Will attend Utilization Review Committee meetings as well as staff meetings
- Ability to handle phone calls on a daily basis to answer questions and requests
- Ability to handle very complex referral process
- Must be LVN or RN
- 5+ years of referral authorization experience
- Excellent handling or resolving phone issues
- Team Player
- Heavy with utilization management background
- Continuity of Care- Ambulatory background
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