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Social Worker
2 weeks ago
Three Rivers HomeCare Grants Pass, United States Full timeWe are hiring for a Social Worker (LCSW OR LMSW) for the Grants Pass and Medford Territories. · Salary base on full-time employment and max productivity: $ $42.00 hourly · Three Rivers HomeCare, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy ...
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Resident Physician
2 weeks ago
Sapphire Innovations Grants Pass, United StatesWe are currently seeking a full-time Assistant Doctor (m/f/d) for Cardiology for our prestigious client, a hospital providing basic and standard care in North Rhine-Westphalia. The department of Cardiology has over 68 beds. This academic teaching hospital offers a variety of trai ...
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Nursing assistant
2 weeks ago
FusionWorks Grants Pass, United StatesWE ARE LOOKING FOR A · Care Assistant (m/f/d) · Seniorenquartier Kaemena Hof · Care assistants support nursing professionals in their work. An untrained care assistant takes on many tasks related to the daily care of elderly and sick people. They help these individuals with daily ...
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Eclipse Enterprises Grants, United StatesWe are looking for a talented planner, team player, customer advisor, and energy expert to join our team as a Plumber, Heating and Air Conditioning Technician (m/f/d). As an expert in building technology, you will ensure that heating systems run smoothly, install and bring to lif ...
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Senior Physician
2 weeks ago
Crimson Solutions Grants Pass, United StatesOur client in Thuringia is seeking reinforcement in the field of pediatrics and adolescent medicine as soon as possible. They are looking for a specialist in pediatrics as a senior physician. The department treats approximately 4,000 patients annually on over 30 beds, both on an ...
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Order picker
2 weeks ago
SilverLinx Josephine, United StatesPicker (m/f/d) Frozen Foods · Welcome to JobImpulse · We are an experienced international staffing agency with an exceptional success story since our founding in 2006. Today, we have over 53 offices in 13 countries and employ more than 9,300 people worldwide. · We are looking fo ...
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Career changer in Business Administration"
2 weeks ago
Velocity Enterprises Gilbert Creek, United StatesAbout Gilbert Creek: · As a traditional family-owned company, we are an excellent specialist in timber construction - THE leading timber construction company in the southwest of Germany. · We offer our customers quality, many years of experience and a wide range of products at a ...
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Expanded Functions Dental Assistant/EFDA
1 day ago
Timber Kids Dentistry Grants Pass, United StatesA Pediatric Dentistry practice is looking for a FUN and energetic Expanded Function Dental Assistant/EFDA that has a desire to grow with our pediatric dental practices. Candidates must be professional, outgoing, well-organized, reliable, team-oriented and must absolutely love wor ...
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Registered Nurse
5 days ago
Medical Solutions Grants Pass, United States$ $ wk (includes wage of ~$22.61-$28.64/hr and per diems if eligible) · click for benefits and other job details · ~$813.94-$ weekly taxable income · ~$1162 in non-taxable per diem (amount subject to eligibility & seasonal/annual adjustment) · This Med Surg (Medical Surgical) in ...
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Travel Med Surg
6 days ago
Medical Solutions Grants Pass, United States$ $ wk (includes wage of ~$22.61-$28.64/hr and per diems if eligible) · click for benefits and other job details · ~$813.94-$ weekly taxable income · ~$1162 in non-taxable per diem (amount subject to eligibility & seasonal/annual adjustment) · Gather 'round, aspiring travel clini ...
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Kitchen Cook
3 weeks ago
Taco Bell Grants, United States Full timeTaco Bell- Grants (Santa Fe Ave) is looking for a hardworking individual to join our kitchen team as a full time or part time Kitchen Cook in Grants, NM. As part of the BOH team, you'll be responsible for food preparation that meets or exceeds hospitality and service standards, a ...
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Restaurant Cook
3 weeks ago
Taco Bell Grants, United States Full timeTaco Bell- Grants (Santa Fe Ave) is looking for a Restaurant Cook to join our team in Grants, NM. This position is full time or part time. The restaurant cook is responsible for food preparation that meets or exceeds hospitality and service standards and must be able to prepare a ...
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Travel Nurse
1 week ago
Cynet Health Grants, United StatesCynet Health is seeking an experienced Nurse Supervisor Licensed Practical Nurse for an exciting Travel Nursing job in Grants, NM. Shift: 3x12 hr days Start Date: 07/01/2024 Duration: 13 weeks Pay: $1332.5 / Week About Cynet Health: · Ranked #5 Best Travel Nursing Companies 2022 ...
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Travel Respiratory Therapist
1 week ago
Triage Grants Pass, United StatesTriage is seeking an experienced Respiratory Therapist for an exciting Travel Allied job in Grants Pass, OR. Shift: Inquire Start Date: 06/24/2024 Duration: 13 weeks Pay: $ / Week Travel Respiratory Therapist | Grants Pass, OR · Travel Cardiopulmonary: Respiratory Therapy Grants ...
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Travel Nurse
1 week ago
GetMed Staffing Grants, United StatesGetMed Staffing is seeking an experienced Long Term Care Licensed Practical Nurse for an exciting Travel Nursing job in Grants, NM. Shift: Inquire Start Date: 06/17/2024 Duration: 13 weeks Pay: $1328 / Week About GetMed Staffing: · GetMed is a medical staffing company that is he ...
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Travel Nurse
1 week ago
Cynet Health Grants, United StatesCynet Health is seeking an experienced Nurse Supervisor Licensed Practical Nurse for an exciting Travel Nursing job in Grants, NM. Shift: 3x12 hr days Start Date: 06/17/2024 Duration: 13 weeks Pay: $1332.5 / Week About Cynet Health: · Ranked #5 Best Travel Nursing Companies 2022 ...
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Restaurant Staff
3 weeks ago
Taco Bell Grants, United States Full timeTaco Bell- Grants (Santa Fe Ave) is looking for a full time or part time Restaurant Staff team member to join our team in Grants, NM. The Restaurant Staff team member is responsible for customer service and commitment to excellence through meeting or exceeding hospitality and ser ...
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Weatherby Healthcare Grants Pass, United StatesIf this opportunity sounds right for you, give us a call today to speak with an expert Weatherby consultant for details. · Willing to wait for license · BC or BE required · Days, Call · Clinic, call and elective surgery · Level 2 trauma, no pelvic · Credentialing needed · ...
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Travel Nurse
1 week ago
Medical Solutions Grants Pass, United StatesMedical Solutions is seeking an experienced Stepdown Unit Registered Nurse for an exciting Travel Nursing job in Grants Pass, OR. Shift: 3x12 hr nights Start Date: ASAP Duration: 13 weeks Pay: $ / Week $ $ wk (includes wage of ~$22.76-$28.80/hr and per diems if eligible) · click ...
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Travel Nurse
1 week ago
Ventura MedStaff Grants Pass, United StatesVentura MedStaff is seeking an experienced Intermediate Care Unit Registered Nurse for an exciting Travel Nursing job in Grants Pass, OR. Shift: 3x12 hr nights Start Date: 06/17/2024 Duration: 13 weeks Pay: $ / Week About Ventura MedStaff: · Founded in 2018 and located in Omaha, ...
bm & ps rn - Grants Pass, OR, US, United States - ALLCARE HEALTH
Description
Benefit Management & Pharmacy Services RN at AllCare Health with the BM & PS teamWe Are Seeking Qualified Candidates to Join Our Team
AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and telecommute, remote work, and flexible schedule options.
This position is responsible for providing efficient and quality utilization management services utilizing clinical knowledge to support achieving optimal clinical and financial outcomes by performing the following duties.
Performs clinical review for cost containment and appropriate utilization of services.
Processes service determinations based on member benefits and clinical criteria.
Conducts concurrent reviews and collaborates with discharge planners for appropriate and safe discharge.
Utilizes resources in a cost effective manner
Identifies members that would benefit from a referral to Care Coordination and initiate internal referrals.
Monitors workflow queues for service determinations to ensure processed within required government timeframe.
Researches and locates applicable federal and/or state criteria and/or health plan policies for service determinations.
Identifies complex cases, prepares, and presents case file to Complex Care Team meetings.
Identifies workflow deficiencies and recommends solutions to improve.
On Call Responsibilities
This position does have intermittent on call responsibilities.
Education & Experience
Bachelor's degree (BA) from a four-year college or university; or one to two years related experience and/or training, or equivalent combination of education and experience.
Knowledge of CPT codes, HEDIS, HIPAA, ICD-10 codes, Medicare guidelines, NCQA, Coordination of benefits where applicable (i.e. Worker's Compensation, Auto Insurance, Short and Long Term Disability), appropriate referrals to Ethics Committee, Corporate Compliance, Fraud and Abuse or Legal Services is required.
Knowledge of billing and claims processing preferred.
Certificates, Licenses and/or Registrations
Current Oregon Registered Nursing License, free of any restrictions or disciplinary action pending, and able to legally and independently practice without the supervision of another licensed professional.
The employee must occasionally lift and/or move up to 10 pounds.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job.
The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.The employee is required to work onsite for all scheduled shifts
The employee is required to work from a home office for scheduled shifts, as needed, if approved by hiring manager% % %%mednurse%%
