Rn Jobs in Tacoma, VA

About The Position

Requirements

• Bachelor’s degree in a job-related field. The stated degree equivalency is graduation from an accredited school of nursing; equivalency does not apply for the Celerian Group, where a bachelor’s degree is required.
• Five years of clinical experience, including direct patient care, appeals, or utilization review.
• Two years of concurrent supervisory or team-lead experience, or equivalent military experience in grade E4 or above.
• Knowledge and understanding of utilization review guidelines and managed care delivery systems.
• Working knowledge of word processing, spreadsheet, and presentation software.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Effective customer service and organizational skills.
• Presentation skills for working effectively with internal and external customers.
• Proficiency in spelling, punctuation, and grammar.
• Analytical or critical-thinking skills.
• Ability to persuade, negotiate, or influence others.
• Ability to handle confidential or sensitive information discreetly.
• Ability to direct, motivate, and assess the performance of others.
• Required software and tools: Microsoft Office.
• Active, unrestricted U.S. RN licensure in the state of hire, an active compact multistate unrestricted RN license under the Nurse Licensure Compact, or— for Division 75 only—active, unrestricted U.S. licensure as a social worker or counselor in the state of hire.

Nice To Haves

• Strong leadership skills and the ability to lead and motivate a team in a positive, productive work environment.
• Clear and effective written and verbal communication skills for interacting with stakeholders at all levels.
• Strong analytical skills for assessing complex cases and making informed decisions.
• Meticulous attention to detail to ensure accuracy and compliance in the appeals process.
• Creative, proactive problem-solving abilities.
• Strong motivation to achieve goals, overcome challenges, and continuously improve.

Responsibilities

• Oversee appeals and case review clinical and support staff and operations, and identify staff training needs.
• Supervise the development and administration of appeals and case review services to meet regulatory, contract, national accreditation, and program requirements, including NCQA, HEDIS, URAC, DOL, DOI, and HIPAA.
• Identify, develop, and implement quality initiatives, compliance oversight, and corrective actions, and provide required quality-improvement reporting.
• Develop and implement tracking, trending, and cost-containment initiatives.
• Provide clinical input and direction for advanced and complicated case reviews.
• Interface with internal and external customers.
• Develop and present appeals and case review educational programs.
• Oversee employee recruitment, hiring, training, and retention strategies.

Benefits

• Subsidized health plans
• Dental coverage
• Vision coverage
• 401(k) retirement savings plan with company match
• Life insurance
• Paid time off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education assistance
• Service recognition
• National discounts for movies, theaters, zoos, theme parks, and more