Posted: Tuesday, September 5, 2017 2:11 AM
Position is located on-site in Columbia, SC Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies and established clinical criteria to service requests or provides health management program interventions. Uses clinical proficiency, claims knowledge/analysis and comprehensive knowledge of health care continuum to assess, plan, implement, coordinate, monitor and evaluate medical necessity, options and services required to support members in managing their health, chronic illness or acute illness. Uses available resources to promote quality, cost-effective outcomes.Required EducationAssociate degree in nursing, ORGraduate of an accredited school of nursing. Required Work ExperienceFour years recent clinical experience in a defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic and general medicine/surgery, ORFour years of utilization review/case management/clinical or a combination; two of the four years must be clinical.Preferred:Renal clinical experience.Renal case management.Dialysis clinic experience.Required Skills and AbilitiesAn active, unrestricted RN license from the United States and in the state of hire OR, An active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC).Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively and make sound decisions. Good judgment. Demonstrated customer-service, organizational and presentation skills. Demonstrated proficiency in spelling, punctuation and grammar. Demonstrated oral and written communications skills. Ability to persuade, negotiate with or influence others. Analytical or critical-thinking skills. Ability to handle confidential or sensitive information with discretion. Microsoft Office skills. EEO StatementWe are an Equal Opportunity/Affirmative Action Employer. We will consider all qualified applicants for employment regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status.
• Location: Columbia
• Post ID: 22817018 columbia