HN04 – Case/Care Management Nurse – Telephonic
HN04 - Case/Care Management Nurse - Telephonic-Management
Kelly Healthcare is seeking LPN or RN Utilization Review Nurse for Workers Compensation i n the Tampa, Florida area. Our customer is a National leading Insurance Company. Staffing for over 60 years, Kelly Healthcare Resources® specializes in providing highly skilled healthcare professionals for the hundreds of positions our clients must fill at any given time. We are a part of Kelly Services®, a US-based Fortune 500 company and the world's most recognized and trusted name in staffing. Our vast network of branch locations allows us to provide quality service to our employees and clients internationally. In addition to working with the most highly respected and innovating companies around the globe; when you work for Kelly Healthcare Resources you can also expect: - Above fair market aggressive compensation package - In person or online career advice and development: i.e. resume coaching, access to our online training center - On-line accessible, accredited CEUs to maintain licensing and/or certification credentials offered free of charge - Unprecedented contract staffing benefits for our employees including seven (7) different and affordable portable options to include: · Benefit Alliance Plan; medical, prescription drug, vision, dental, life insurance, critical illness, accident insurance and or short term disability benefits · Access2Wellness; · Group Home Auto Discount Program; · Employee discount Program to include numerous employee discounts at popular retailers, hotels, entertainment attractions, cellular companies, and universities Summary: Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with client?s-specific contract rules and guidelines and with company?s policies, practices, and procedures to facilitate quality and cost effective care for the injured employee. · Performs utilization review activities including pre-certification, concurrent, and retrospective reviews according to guidelines. · Determines medical necessity of each request by applying appropriate medical criteria to first level reviews and utilizing state or state recommended guidelines (if available). · Assists with the negotiation of the appropriate length of care or alternative level of care when allowed by state jurisdiction. · Refers case to a review physician when the treatment request does not meet necessity per guidelines, when guidelines are not available, or per customer account instructions. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the requesting provider in accordance with departmental policy and within state or URAC mandated turnaround times. · Reviews, documents, and communicates all utilization review activities and outcomes including, but not limited to, all calls made and received in regard to case communication and all demographic and service group information. Sends appropriate system-generated letters to provider, claim payer, claimant, and claimant?s attorney. · Coordinates the appeal process as applicable with requesting and utilization review physician. · May provide guidance and coaching to other utilization review nurses and participate in the orientation of newly hired utilization nurses. · Performs other dutie s as assigned Requirements: · Active Licensed Practical Nurse (LPN) or Registered Nurse (RN) license required · Minimum of 3 years clinical practice experience required. · Previous managed care and/or utilization review experience. · Workers Comp experience preferred. · Strong problem solving and analytical skills. · Excellent communication, organizational, and interpersonal skills. · Proficiency with standard software applications including spreadsheets and word processing. For immediate consideration, please email your resume to Ana Diaz, Sr. Healthcare Recruiter, at diazana@kellyservices.com or by clicking the ?apply now? button. Be sure to call 813-882-0933 to confirm receipt. Please continue to check our website for nationwide openings at www.kellyhealthcare.com . We look forward to hearing from you!