Partnership HealthPlan of California
Lead Nurse Coordinator (LVN/RN)
Partnership HealthPlan of California, California, Missouri, United States, 65018
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Lead Nurse Coordinator (LVN/RN)
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Partnership HealthPlan of California . Provides assistance with oversight during the daily operations of the outpatient review process. Participates in training and mentoring team members. Supports staff and assists in determining the appropriateness, quality, and medical necessity of requested services. Responsibilities
Oversees daily outpatient review operations. Provides direction, support, and training to staff. Evaluates medical appropriateness using benefit interpretation, policies, and InterQual criteria. Documents patient records accurately. Participates in quality improvement and inter-rater reliability studies. Assists in coverage for additional review responsibilities as needed. Collaborates with other departments to resolve authorization issues. Participates in special projects. Qualifications
Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with two years of managed care experience. Knowledge of utilization management and managed care protocols. Current California LVN or RN license. Strong organizational, communication, and decision-making skills. Work Environment
Primarily office-based with computer work, able to lift objects up to 10 lbs., and manage multiple priorities. Additional Information
Salary ranges: LVN: $49.54 - $64.41; RN: $56.98 - $74.07. This job posting is active and not expired. #J-18808-Ljbffr
Lead Nurse Coordinator (LVN/RN)
role at
Partnership HealthPlan of California . Provides assistance with oversight during the daily operations of the outpatient review process. Participates in training and mentoring team members. Supports staff and assists in determining the appropriateness, quality, and medical necessity of requested services. Responsibilities
Oversees daily outpatient review operations. Provides direction, support, and training to staff. Evaluates medical appropriateness using benefit interpretation, policies, and InterQual criteria. Documents patient records accurately. Participates in quality improvement and inter-rater reliability studies. Assists in coverage for additional review responsibilities as needed. Collaborates with other departments to resolve authorization issues. Participates in special projects. Qualifications
Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with two years of managed care experience. Knowledge of utilization management and managed care protocols. Current California LVN or RN license. Strong organizational, communication, and decision-making skills. Work Environment
Primarily office-based with computer work, able to lift objects up to 10 lbs., and manage multiple priorities. Additional Information
Salary ranges: LVN: $49.54 - $64.41; RN: $56.98 - $74.07. This job posting is active and not expired. #J-18808-Ljbffr