*quality management nurse consultant - united states, woonsocket
adecco is currently assisting a local client, recruiting for quality management nurse consultant ?working from home. this role is expected to be for 8 week duration!? for instant consideration,?apply now!
schedule: monday-friday
8 am- 5pm cst (one hour unpaid lunch)
7:30 am-4:30 pm cst (one hour unpaid lunch)
7am-4pm cst (one hour unpaid lunch)
quality management nurse consultant is responsible for the review and evaluation of clinical information and documentation. reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. independently coordinates the clinical resolution with internal/external clinician support as required.
reviews documentation and evaluates the necessity of provider requests, but applying national and state based criterion, thus conducting medical necessity review.
staff may be required to contact the providers of record, vendors, or internal aetna departments to obtain additional information.
accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
condenses complex information into a clear and precise clinical picture while working independently
candidates must meet the following requirements to be considered:?
requires an rn with unrestricted active license
1+ years of inpatient hospital experience (recent)
excellent verbal and written communication and interpersonal skills w/ ability to maintain patient confidentiality
able to work in multiple it platforms/systems
must have familiarity working with: qnxt and medcompass experience
excel knowledge using spreadsheets, navigating drop downs, filters, querie
?
this employer requires all employees, temporary labor, consultants, and contractors to be fully vaccinated against covid-19 by their start date (other date may be inserted if start date is not accurate), subject to approved medical or religious exemptions.?
equal opportunity employer/veterans/disabled
the company will consider qualified applicants with arrest and conviction records
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