A rapidly growing insurance brokerage and consulting firm.
Provide ongoing support and expertise through comprehensive assessment, coordination, implementation and evaluation of individual patient needs and Kunkel Care Solutions programs. Responsible for ensuring quality patient care while conserving healthcare dollars through utilization review, case management, and on-site nurse advocacy.
- Assist in program implementation to include utilization management, case management, and on-site nurse advocacy.
- Review precertification requests for medical necessity
- Utilize internal software program to input information
- Establish effective rapport with clients, patients, families, and professional support staff
- Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to promote improved quality of care, cost effective and appropriate medical outcomes, decreased lengths of hospital stays, and continuity of care
- Provide patient-focused case management to improve quality of care and cost savings
- Help patients make informed decisions by acting as their advocate regarding their clinical status and treatment options
- Maintain client records by reviewing case notes; logging events and progress; creating and sending all necessary documentation
- Provide timely reports projecting cost for future needs and statements of prognosis
- Conduct on-site nursing assessments to discuss current health status, care needs and optimal outcomes
- Compile statistical analysis for health plans, and employer groups regarding engagement rates, success rates, return on investment, and annual reporting measures, for employees participating in health plan
- Evaluate patient satisfaction and quality of care provided
- Other duties as assigned
- Associate or Bachelor degree earned through an accredited nursing course.
- Minimum of five years clinical nursing experience and/or two years of utilization review/case management experience.
- Maintain current professional licensure in nursing.
- Appropriate certification in case management preferred, however not required.
- Mandates continuing education requirements.
- Must be able to cope with mental and emotional stress related to working with persons who are ill, disabled, elderly and/or emotionally upset.
- Highly effective in working objectively with a diverse group of people and must demonstrate communication, organizational, and administrative skills.
- Proficient in Outlook, Word, Excel, and medical management software
Interested applicants are encouraged to apply for immediate consideration