Rn Jobs in St Cloud

About The Position

Requirements

• Graduate from an accredited School of Nursing.
• Hold a current, active, unrestricted license to practice as a Registered Nurse in the State of Oklahoma.
• Knowledge of managed care and associated group benefit plans.
• Strong oral and written communication skills.
• Ability to reason logically and use good judgment when interpreting materials or situations.
• Knowledge of community-based resources.
• Excellent organizational skills and ability to perform multiple tasks.
• Proficiency in Microsoft applications.
• Excellent time management and documentation skills.
• Successful completion of a Health Care Sanctions background check.

Nice To Haves

• Three years of acute care experience preferred.
• Two years of experience working with population health preferred.
• Previous discharge planning or case management experience preferred.
• Managed care experience is a plus.

Responsibilities

• Perform utilization review of outpatient and ancillary services, as well as inpatient and post-acute services when indicated.
• Determine medical necessity and appropriateness of services using clinical review criteria.
• Accurately document review determinations and contact providers and members according to established timeframes.
• Identify and refer cases that do not meet established clinical criteria to the Medical Director.
• Identify and refer quality issues to Medical Management leadership.
• Identify potential cases for Care Management programs.
• Collaborate with physicians and other providers to facilitate services throughout the health care continuum.
• Perform accurate data entry.
• Communicate appropriate information to other staff members as necessary or required.
• Participate in continuing education initiatives.
• Collaborate with other departments as needed.
• Perform other duties as assigned.