Exception Nurse III

Modivcare • Greenville, SC

13d • $29 - $39

About The Position

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! This position is responsible for reviewing non-emergency medical transportation requests for assignment of medically appropriate modes of transport. This role… Obtains applicable information and/or documents to make medical determinations. Works closely with staff to contribute to the quality assurance of these trips. Assists with the development of policies and procedures for the medical exception functions. Assists with medical exception functions across multiple sites. Reviews all mode of transport upgrades/special requests to assure appropriate utilization of resources. Screens all medical documentation and make decisions based on provided information to determine the most efficient and appropriate. method of transport or most appropriate medical provider. Maintains client confidentiality by compliance with HIPPA guidelines and the company' confidentiality policy. Acts as a resource for staff for all medical questions. Actively work with the Exceptions team. Make suggestions for and updates policies and procedures as needed. Assist in appeal and denial processes. Performs other duties as assigned.

Requirements

• RN with an active state license required
• Two (2) plus years of clinical experience
• Knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services
• Broad knowledge of health care systems including hospital, nursing home and community medical knowledge
• Analytical Skills - Strong ability to use thinking and reasoning to solve a problem
• Communication, Oral - Excellent ability to communicate effectively with others using the spoken word
• Communication, Written - Excellent ability to communicate in writing, clearly and concisely
• Customer Oriented - Excellent ability to take care of the customers’ needs while following company procedures
• Decision Making - Ability to make critical decisions while following company procedures
• Interpersonal - Ability to get along well with a variety of personalities and individuals
• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions
• Proficient in the use of Word, Excel, Outlook, and PowerPoint
• Excellent oral and written communication skills
• Management Skills - Excellent ability to organize and direct oneself and effectively supervise others
• Excellent ability to find a solution for or to deal proactively with work-related problems
• Ability to effectively build relationships with customers and co-workers
• Driven ability to complete assigned tasks under stressful situations

Nice To Haves

• Prior experience in a medical office preferred; social services or case management experience is a plus
• Or equivalent combination of education and/or experience

Responsibilities

• reviewing non-emergency medical transportation requests for assignment of medically appropriate modes of transport
• Obtains applicable information and/or documents to make medical determinations
• Works closely with staff to contribute to the quality assurance of these trips
• Assists with the development of policies and procedures for the medical exception functions
• Assists with medical exception functions across multiple sites
• Reviews all mode of transport upgrades/special requests to assure appropriate utilization of resources
• Screens all medical documentation and make decisions based on provided information to determine the most efficient and appropriate method of transport or most appropriate medical provider
• Maintains client confidentiality by compliance with HIPPA guidelines and the company' confidentiality policy
• Acts as a resource for staff for all medical questions
• Actively work with the Exceptions team
• Make suggestions for and updates policies and procedures as needed
• Assist in appeal and denial processes
• Performs other duties as assigned

Benefits

• Medical, Dental, and Vision insurance
• Employer Paid Basic Life Insurance and AD&D
• Voluntary Life Insurance (Employee/Spouse/Child)
• Health Care and Dependent Care Flexible Spending Accounts
• Pre-Tax and Post --Tax Commuter and Parking Benefits
• 401(k) Retirement Savings Plan with Company Match
• Paid Time Off
• Paid Parental Leave
• Short-Term and Long-Term Disability
• Tuition Reimbursement
• Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees