The Nurse Manager provides comprehensive nursing care and/or patient services in a clinic or ambulatory care setting, assisting physicians and patients.
Scope of Work:
This position will work between the organization’s many facilities, as assigned, providing case management to patients. The Nurse Manager works under the general supervision of the Director of Referred care.
Essential Duties and Responsibilities:
Provides review of referrals for specialty and hospital-based services and determines whether requests are appropriate under Purchased Referred care criteria.
Identifies alternate resources available to patients, i.e., Medicare, Medicaid, private insurance.
Provides approval/denial of patients’ requests for services.
Reviews medical records documentation to support services accomplished through admission certification and continued-stay certification according to Interqual intensity of service and severity of illness criteria.
Identify and refer patients to other agencies/programs such as AHCCCS, ALTC, DDD, CRS, when appropriate, as well as identify and refer members for Coordination of Benefits (COB) and Third-Party Liability (TPL),when appropriate.
Represents Organization as a resource person for, and liaison between physicians and hospital/skilled nursing facility staff.
Coordinate discharge planning for all hospitalized patients by facilitating hospital discharge plans with hospital and/or skilled nursing facility staff. Attends and facilitates weekly discharge planning with case managers and other departments as needed.
Exercises independent judgement in the development and distribution of various reports required to track utilization trends of patients and providers.
Responsible for tracking of high cost cases and submission of catastrophic Health Emergency Fund (CHEF) requests. Reports are provided to appropriate personneland committees.
Performs special projects and other duties as assigned.
Knowledge, Skills, and Abilities:
Ability and sensitivity to minority communities.
Knowledge of HIPAA related rules and regulations.
Knowledge of a full range of established nursing concepts, principles, and practices to perform an inpatient utilization review.
Knowledge of current utilization management principles, criteria, standards, guidelines, and discharge planning processes, to analyze medical records concurrently for necessity and appropriateness of admissions and continued stays.
Associates’ Degree in Nursing
Bachelor's Degree in Nursing preferred.
Valid, unrestricted license as a Registered Nurse issued by the Arizona State Board of Nursing (or issued by another state recognized by the Arizona Board of Nursing as a multi-compact license state) with no current, pending, or prior disciplinary action on nursing license.
Two-years nursing experience in a clinical setting as a Registered Nurse.
Must have a current certification in Cardio Pulmonary Resuscitation (CPR), and Automated External Defibrillator (AED).
Must have a current immunization statement to include, proof of a non-reactive tuberculosis skin test within the last year, proof of immunity for hepatitis B (Documentation of immunization does not prove immunity, only a titer with a positive result is proof), within three months of hire.
Upon recommendation for hire a criminal background and National FBI check is required to determine suitability for hire.
Must possess and maintain a valid Arizona driver's license (no DUIs or major traffic citations within the last three years).
Must submit a 39-month driving record with employment application.
We are an equal opportunity employer and welcome applications from all suitably qualified persons regardless of their race, sex, disability, religion/belief, sexual orientation or age.
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APN is a National, Full–Service Staffing and Recruiting business, spanning the Automotive, Motorcycle, Transportation, Healthcare, IT and Construction industries.
Since 1991, we have been providing:
Employment Management Advice
Professional Employment Services (PEO)
Automotive Repairs and Maintenance
Fuel and Water Tanker Trucks for Sale
We also provide Career Management and Coaching for Executive Level Individuals looking to advance or re-engineer their careers.
We work with our clients and candidates to thoroughly understand their specific needs, their personality and style, so we efficiently and effectively match candidates and employers on both technical and personal characteristics.