**************************************************************
JobCircle.com is the largest regional job board in the
Mid-Atlantic region, with tens of thousands of job offerings
in PA, NJ, DE, MD, NY, and Washington D.C.  To learn more,
visit http://www.jobcircle.com?source=ng
**************************************************************

Job Title:     Concurrent Review Coord Job
Job Location:  AZ: Scottsdale
Pay Rate:      competitive
Job Length:    full time
Start Date:    2012-11-13

Company Name:  Coventry Health Care
Contact:       Karen Vargas
Phone:         Apply Online
Fax:           Apply Online

Description:   Description:

GENERAL SUMMARY

Reviews all inpatient admissions to assure appropriate level of care. Coordinates with physicians, staff, and facilities regarding patient care. In conjunction with and under the supervision of physicians, evaluates care plans and discharge plans, monitors all clinical activities, identifies alternative levels of care when requested care is not covered, identifies cost-effective protocols, and develops guidelines for coverage of benefits.

ESSENTIAL RESPONSIBILITIES

- Monitors all inpatient care provided to members. In conjunction with and under the supervision of physicians, evaluates and provides feedback to treating physicians regarding a members discharge plans and available covered services including identifying alternative levels of care that may be covered.
- Coordinates, directs, and performs concurrent and retrospective reviews; monitors level and quality of care. Responsible for the proactive management of acutely and chronically ill patients with the objective of improving quality outcomes and decreasing costs.
- Coordinates an interdisciplinary approach to support continuity of care. Identifies covered services, including utilization management, transfer coordination, discharge planning, and issuance of all appropriate authorizations for covered services as needed for outside services for patients/families.
- Consults with physicians, health care providers, and outside agencies regarding continued care/treatment or hospitalization.
- Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum. Develops and collects data, and trends utilization of health care resources.
- Interprets health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies. Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies. Makes referrals to appropriate community services.
- Responsible for the early identification and assessment of members for admittance to a comprehensive case management program.
- Actively participates in the discussion and notification processes that result from the medical record reviews with the facilities. Prepares notification letters of denied and negotiated days within the established time frames.
- Assists in the identification and reporting of potential quality improvement issues. Responsible for assuring these issues are reported to the Quality Improvement Department.
- Performs other duties as required.

Qualifications:

JOB SPECIFICATIONS

- Registered nurse with active state RN license preferred.

- Significant (usually 3+ years) clinical experience.

OR

- Licensed Practical Nurse with active state LPN license.

- Minimum 3 years clinical experience required, and
- Minimum 5 years managed care or equivalent experience.
- BachelorTMs degree preferred.
- Previous case management experience preferred.
- Demonstrated experience in utilization management, discharge planning, or transfer coordination.
- Valid driverTMs license and a reliable personal vehicle for travel between work and hospitals is required.

Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: Professionals
Primary Location: Scottsdale, AZ, US
Organization: 42042 - FEHBP - Home Office
Schedule: Full-time
Job Posting: 2012-08-15 00:00:00.0
Job ID: 1210979

Please refer to Job code 2096964A3 when responding to this ad.

For FASTEST PROCESSING of your resume, please visit http://www.jobcircle.com/classifieds/11389966.html?source=ng to apply online.

**************************************************************
For fastest processing of your resume, this employer asks that
you apply to this job using the URL above.
**************************************************************