UR Nurse, RN or LPN job at Coventry Workers Comp Services in Hazelwood

Coventry Workers Comp Services is at the momment seeking for UR Nurse, RN or LPN on Thu, 07 Nov 2013 08:15:22 GMT. UR Nurse, RN or LPN Hazelwood, MO Utilization Review Nurse (WC) Coventry Health Care was established in 1986 as a provider of managed health care services, offering members a wide choice of options, high standards of care and affordable rates. Since our founding, Coventry has experienced dramatic growth, increasing membership and an expansion of its service areas. GENERAL SUMMARY: Responsible for...

UR Nurse, RN or LPN

Location: Hazelwood Missouri

Description: Coventry Workers Comp Services is at the momment seeking for UR Nurse, RN or LPN right now, this job will be placed in Missouri. More complete informations about this job opportunity please give attention to these descriptions. Hazelwood, MO
Utilization Review Nurse (WC)
Coventry Health Care was established in 1986 as a provider of managed health care services, offering members a wide choi! ce of options, high standards of care and affordable rates. Since our founding, Coventry has experienced dramatic growth, increasing membership and an expansion of its service areas.

GENERAL 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.

ESSENTIAL RESPONSIBILITIES:
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 alt! ernative 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 turn around 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.
Perfor! ms other duties as assigned.
Job Requirements

JOB SPECIFICATIONS:
Current RN or LPN license required.
Minimum of 2 to 3 years clinical practice experience required.
Previous managed care and/or utilization review experience required.
Strong problem solving and analytical skills.
Excellent communication, organizational, and interpersonal skills.
Proficiency with standard software applications including spreadsheets and word processing.

Contact:
Anne Biggs
Regional Recruiter
Coventry Workers' Comp Services
www.cvty.com
Requisiton #1313238
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to Coventry Workers Comp Services.

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This job starts available on: Thu, 07 Nov 2013 08:15:22 GMT

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