Nurse Navigator - Wheeling - The Health Plan of West Virginia Inc

Description

Job Title

Clinical Care Coordinator

Summary

We are seeking a Registered Nurse with at least five (5) years experience to join our team as a Clinical Care Coordinator. The ideal candidate will have a strong background in nursing, excellent communication skills, and the ability to work independently in a fast-paced environment.

Responsibilities

• Conducts telephonic and/or on-site admission, concurrent or retrospective review of all inpatient admissions and observation stays.
• Enters data timely and updates principle/secondary diagnoses and procedures, medical histories, and consults.
• Investigates missed admissions obtaining pertinent details and refers to the Medical Director as appropriate with completion of documentation and follow up.
• Determines appropriateness of admission and continued stay using established clinical criteria.
• Refers admissions/continued stays with questionable medical necessity to the Medical Director with completion of documentation and follow-up.
• Coordinates care in collaboration with the member, family, health care team members, hospital utilization review, social workers, and other resources to intervene proactively to identify needed medical services, utilization and discharge issues, modifiable risk factors, educational needs and available resources to affect individual health care outcomes positively.

Requirements

• Registered Nurse with at least five (5) years experience. Two (2) of those years may be work experience as a nurse's aide, LPN or other appropriate position in a clinical setting.
• Active Ohio and WV licensure which must be maintained throughout employment, including compliance with State Boards of Nursing continuing education policy.

Preferred Qualifications

• Any Registered Nurse with a combination of academic education, professional training or work experience which demonstrates the ability to perform the duties of the position would be considered.
• Utilization Management, Quality Improvement, Case Management, Disease Management or other Managed Care experience would be helpful.

Estimated Salary

$85,000 - $110,000 per year