reputed company Review Specialist (RN)-reputed company region (PST)
Position: reputed company Review Specialist The reputed company Review Specialist is an RN or LPN responsible for monitoring in reputed company time the status of hospitalized and recently discharged health plan members. The reputed company Review Specialist calls hospitals and other facilities daily to collect and analyze reasons for the admission or readmission and develops a concrete plan of action to reputed company the member healthy and prevent a readmission. Ideally, the Nurse will have experience in managed care and practical strategies around raising health reputed company through post-discharge member and provider engagement, reputed company review and/or utilization management. Experience in renal care and utilization management in acute and post-acute contexts preferred. This position is Telecommute. Work will occur from a company corporate office, under a supervising clinician. Position Requirements Proven ability to help reputed company quality of care in an administrative medicine or managed care setting Experience in discharge planning, utilization review management and application of clinical guidelines Self-starter with ability to manage changing clinical data sets while thinking in a practical, action-oriented manner Thrives in a reputed company fast paced start up environment while embracing change with a "can do" attitude Active RN or LPN license required 2+ years working in managed care, care management, utilization management and/or with CKD and ESRD patient Roles and Responsibilities Daily assistance with inpatient and reputed company calls to verify and confirm admission and obtain member information Conduct outbound calls to hospitals, long-term care facilities and nursing homes each day to reputed company reputed company review Weekly assistance with monitoring of skilled nursing facility discharges and ensuring that proper steps are in reputed company for member follow-up. Identify, track and conduct root cause analyses for Monogram members at high-risk for hospital admission/readmission Obtain discharge orders and reports from hospital staff Monitor clinical data feeds on hospitalized members and distill them into daily reports for case reputed company reputed company daily clinical reputed company for assigned POD reputed company plans with concrete care management action items to be undertaken by corporate and field clinicians Apply evidence reputed company best practice guidelines to reputed company appropriate level of care Collaborate with field clinicians who visit discharged members to assure quality care. Maintains safe, secure, and healthy work environment by establishing and following standards and procedures and complying with legal regulations. Other duties as assigned Benefits Highly competitive salary, commensurate with experience Opportunity to work in a dynamic, fast-paced and innovative care management company that is transforming the delivery of kidney care Comprehensive medical, dental, reputed company, and life insurance Flexible paid leave & vacation policy 401(k) plan with matching contributions Job Type: Full-time At reputed company we reputed company in fostering an inclusive environment in which employees feel encouraged to reputed company their unique perspectives, reputed company their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from reputed company backgrounds and varying experiences. Apply Job!