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 Pre-Certification Nurse - Towson, Maryland, United States

   
Job information
Posted by: Chesapeake Employers' Insurance Company 
Hiring entity type: Insurance 
Work authorization: Existing work authorization required for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: 401(k) -
Health Insurance -
 
Relocation: No relocation assistance provided 
Position functions: Nursing - Clinic RN
Nursing - Other
Nursing - Staff RN
 
Travel: Minimal 
Accept candidates: in same state/locale 
Languages: English - Native
Spanish - Conversational
 
Minimum education: Bachelor Degree 
Minimum years experience:
Resumes accepted in: English
Cover letter: No cover letter requested
Virtual interview questions: No questions which require answers when applying for this job posting.
Job code: / Latpro-3652335 
Date posted: Dec-07-2018
State, Zip: Maryland, 21286

Description

POSITION SUMMARY:

Responds in a timely manner to provider requests for pre-authorization of medical services, as well as ensuring quality care to the injured workers, in accordance with the Maryland Medical Fee Schedule regulations and Chesapeake Employers policy.

DUTIES AND RESPONSIBILITIES:

- Retrieves service requests and reviews for service determination.
- Reviews claim information for appropriateness of medical service.
- Reviews medical records for description of injury and related treatments.
- Applies treatment guidelines, medical policy and nursing judgement to each authorization decision.
- Notifies provider of authorization decision or makes request for information necessary to make service determination, within 72 hours of initial call and coordinates follow-up as necessary.
- Communicates with Claims Adjusters and Nurse Case Managers, as required, to facilitate response to the provider.
- Faxes notification of authorization decision to provider the same day.
- Documents all activities in notepad.
- Follows established utilization review policy and protocol.
- Utilizes and monitors preferred vendors for select services to ensure prompt, cost effective service.
- Responsible for interdepartmental communication necessary to provide optimal customer service.
- Supports pharmacy program and other specialty programs within, or supported by, Health Services.
- Responsible for customer service, exceeding expectations.


Requirements

SKILLS, EDUCATION AND EXPERIENCE:

- Current Maryland RN License.
- Utilization review or case management experience preferred.
- Certification in related fields is preferred.
- 2 years of active nursing experience in orthopedic, medical/surgery, emergency room, intensive care or occupational medicine is preferred.
- Prior workers' compensation experience is preferred.
- Strong interpersonal skills.
- PC skills Windows, Word, Excel
- Bilingual skills preferred.

POSITIONAL COMPETENCIES:

- Analytical Thinking/Problem Solving
- Customer Experience Management
- Drive for Results
- Influence/Negotiation
- Organizational/Time Management
- Practical Knowledge

PHYSICAL DEMANDS:

While performing the duties of this job, the employee is regularly required to sit, use hands to finger, handle or feel objects, tools or controls; reach with hands and arms. The employee is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The employee may occasionally lift up to 30 pounds. Specific vision abilities are required which include, close vision, peripheral vision and the ability to adjust focus.

WORK ENVIRONMENT:

Office Environment. The noise level is usually moderate.