REGISTERED NURSE (Authorization Review Unit)
US Tech Solutions
US Tech Solutions is seeking a “REGISTERED NURSE (Authorization Review Unit (a.k.a. Prior Authorization)” for a 12 month contract with possible extension position with a client in Augusta, ME 04333, USA
Job Poster: Keshav Sharma
As a Registered Nurse, you will work closely with existing care coordination capacity in the community to maximize the efficient use of state resources to identify and fill in gaps where no care coordination capacity exists for high need MaineCare members. You will partner with hospitals and providers to conduct clinical reviews of members using the Emergency Department (ED) for avoidable reasons identified through claims data and ED daily census. You will educate providers and members on resources available to assist with referrals as needed and will coordinate and participate in community team meetings with providers for MaineCare members that are more difficult to manage. You will collaborate with staff regarding other initiatives within MaineCare.
In performing this work your duties will include but are not limited to, the following:
· Develop and implement a targeted plan of care to decrease avoidable emergency department usage for MaineCare members.
· Partner with hospitals to provide ongoing education to MaineCare members and the MaineCare Provider community.
· Work with other members of the Care Coordination Unit to monitor work queues and complete assigned tasks.
· Collect data and prepare records, reports and statistical information to assist in the evaluation and measurement of wellness programs and the ED Collaborative
· Develop plans of care for clinically complex MaineCare members.
· Attend conferences regularly for wellness initiatives available within the community.
· Provide outreach to MaineCare members in the community via phone, mail, and fax.
· Perform other duties and responsibilities as assigned.
KNOWDEDGE AND CERTIFICATION REQUIRMENTS:
· Knowledge of the principles and methods of professional nursing practice.
· Knowledge of current standards of care and practices relating to services provided by health care facilities, agencies, and practitioners.
· Ability to plan, organize, and direct the work of others.
· Ability to maintain objectivity and professionalism during unusual and stressful circumstances.
· Ability to communicate effectively.
· Ability to write clearly and effectively.
· Ability to draw valid conclusions, use critical thinking skills, and make independent decisions.
· Ability to establish and maintain effective working relationships.
FULL PERFORMANCE KNOWLEDGES, SKILLS AND ABILITIES REQUIRED: (These may be acquired on the job and are needed to perform the work assigned).
· Knowledge of state and federal regulations relative to the qualifications of health care professionals and paraprofessionals.
· Knowledge of community organizations and resources.
· Knowledge of state licensing and federal certification regulations for health care providers.
· Knowledge of federal and state accreditation commissions and standards.
· Knowledge of Department policies and procedures.
· Knowledge of the Maine Medical Assistance Manual.
· Ability to interpret and apply federal and state rules and regulations.
· Ability to provide technical assistance.
· Ability to develop and implement corrective actions.
Licensed Nurse and three (3) years of progressively responsible experience in the field of nursing and/or in the delivery of health care services.
Licensed as a Registered Professional Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Maine as issued by the State Board of Nursing. RN is preferred; however, an LPN is acceptable if a RN is not available.
About US Tech Solutions:
Your talent, our opportunities - This is the premise behind US Tech Solutions.
You have the skill we have the opportunity. As a team, we work passionately for you to get the right career opportunity across industry verticals and functions. For past sixteen years, leading Global
Companies and Fortune 500 come to us to get the right talent. Whether you want to work as full-time, contractor or part-time, technical or non-technical our talent consultants will connect with the right career opportunity globally.
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USTECH was founded in 2000 by Manoj Agarwal. Today, we are a global firm offering talent solutions to 150 customers including 20% of Fortune 500 across Financial Services, Healthcare, Life Sciences, Aerospace, Energy, Retail, Telecom, Technology, Manufacturing, and Engineering. We are headquartered in New Jersey with 40 global locations across the USA, Canada, Europe, and India. Deloitte has recognized USTECH as one of the fastest growing private businesses for the past five consecutive years and INC 500 for the past three. We have also been rated “The Top Business in the US" by Diversity Business since 2011. To learn more about how US Tech Solutions visit our website: www.ustechsolutions.com.
“U.S. Tech Solutions, Inc. is an Affirmative Action, Equal Opportunity Employer. Our employment decisions are made without regard to race, color, religion, gender, national origin, age, disability, marital status, veteran or military status, or any other legally protected status.”