RN Case Manager (St. Louis, MO) at / RN Jobs

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RN Case Manager (St. Louis, MO)

at in St. Louis, MO

Clinical Case Manager II - (Contract Assignment)
Min Requirements - Must be RN with MO License with 1 year of Utilization Management/Utilization Review experience from a managed care company. Must have 2+ years of clincial background experience.
Formal Job Description:
Clinical Case Manager II at our St. Louis, MO location. This role is responsible for coordination of daily Utilization Management functions in accordance with our policies, procedures and processes. Functions as a clinical resource for other licensed and non-licensed UM staff. Interacts with the Medical Directors, staff, and providers in a quality, cost effective healthcare services for our members.
REQUIRED QUALIFICATIONS:
Education:
Bachelor of Science in Nursing preferred
Experience:
Minimum 5 years acute care clinical experience (medical/surgical, E.R., ICU)
Minimum 3 yrs Utilization Management experience in Managed Care.
Knowledge of applicable state, federal and third party regulations and standards (Medi-Cal Title 22, 10, CCS Program).
Licensure/Certification:
Valid MO State RN license
UM Certification/CM Certification preferred
KNOWLEDGE, SKILLS AND ABILITIES:
Computer experience in a Windows environment with ability to learn new information systems and software.
Knowledge of a variety of clinical areas of medical treatment;
Knowledge of Interqual Utilization Criteria;
Knowledge of hospital/patient care facilities, current practices, procedures, acceptable medical treatment and diagnoses;
Skill to learn company policies and procedures as they relate to hospital authorization/denials, physician review, appeals, etc.;
Skill to successfully apply established guidelines and regulations to specific and individual situations;
Skill in both oral and written communications to ensure the accurate transferal of information and to build rapport that will ensure the trust, confidence and cooperation of others in work situation;
Skill in establishing and maintaining a variety of records necessary to provide complete information and documentation for relevant and appropriate medical determination;
Skill to establish and maintain effective work relationship with those contacted in the performance and documentation for relevant and appropriate medical determination;
Skill to establish and maintain effective work relationships with those contacted in the performance of required duties.
Excellent verbal and written communication skills
PRINCIPLE ACCOUNTABILITIES:
Contact assigned hospitals by phone or fax to review member's medical records and collect additional data concurrently; maintains medical records of hospitalized members, which reflect accurate clinical picture and scope of care provided; documents in QNXT appropriately. Maintain confidentiality of all information relating to members and care providers. Location: St. Louis, MO
Compensation: $27-$28 HR
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