Registered Nurse (RN) Opportunities
Location: Buffalo New York
Description: HealthNow New York Inc. is presently looking of Registered Nurse (RN) Opportunities right now, this occupation will be placed in New York. More complete informations about this occupation opportunity kindly see the descriptions. At BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, our nurses consistently offer the right care at the right time â€" in a very unique working environment. See for yourself how healthy works.
Flexible work environment
No weekends, holidays, or on-calls
Generous benefits
Growth opportunities
Opportunities include:
Case Management (telephonic) - Provide telephonic consultation and health teaching using established evidence-based clinical and preventive health guidelines. This initiative provides the continuum of health services necessary to improve health, prevent and control disease and have a measureable impact on health related costs. Ensure quality, cost-effective care is delivered to members of all product lines of HealthNow NY Inc. This position will also assess, plan, implement and evaluate the options and services to meet an individual’s health needs.
Disease Management (telephonic) - Triage referrals using a systematic approach to identify members who would benefit from Disease Management or Case Management using professional clinical judgment. Telephonically screen members via data analysis (e.g. high dollar, utilization trigger reports - readmission, inpatient), predictive modeling, reports or by internal or external referral sources. Route members appropriate for case management to the Case Management queue and provide telephonic consultation and health teaching to those appropriate for Disease Management using established evidence-based clinical and preventive health guidelines. This initiative provides the continuum of health services necessary to improve health, prevent and control disease and have a measureable impact on health related costs.
Use (Utilization) Management - Pre-Op/Post-Op, In/Outpatient. Ensuring that quality, cost-effective care is delivered to members of all product lines of HealthNow New York Inc. Assists in containing the cost of health care services by supporting proper utilization of member benefits and detecting, resolving and preventing improper utilization of member benefits.
Healthcare Quality Improvement - Develop & coordinate quality improvement activities/interventions to improve the health of our customers and the healthcare services of our providers. Includes: patient safety, medical record review, quality reviews, health care data collection, coordination of care, provider education and participation in local or state coalitions. Participates on health improvement internal and external teams. Activities are aligned with meeting corporate goals, National Committee for Quality Assurance, Department of Health and, Centers for Medicare and Medicaid Services standards.
Fraud and Abuse Investigation - Responsible for identifying potential and actual fraud/abuse through comprehensive medical record and claims review of all HealthNow contracted providers. Initiate and complete provider audits, post-audit provider education and evaluation to ensure corporate and regulatory compliance.
Required Skills
Excellent time management skills
Excellent verbal and written communication skills
Ability to work effectively with minor supervision
Must be able to work in a fast-paced environment with daily work processing deadlines
High energy level and ability to project enthusiasm
Persuasive communication style
Polished, professional image and reputation
Demonstrated customer service orientation
Demonstrated personal accountability
Knowledge of MS Word, Excel, Access, and Internet preferred
Knowledge of case management, managed care, health insurance industry, and the provider community a plus
Required Experience
Preferred Education:
Associates Degree in Nursing is required.
Alternate Education:
Bachelors Degree in Nursing(BSN) is preferred.
Preferred Experience:
1 full year of employment as an RN in an acute hospital setting is required.
3 years of clinical experience including medical office, clinic, home care or agency is appropriate.
Other experience specific to the actual position may be required and will be determined a time of posting.
Employment longevity of 2 or more years is strongly preferred.
Three positive professional references must be obtained prior to offer of employment.
Required Licenses/Certifications:
Current and valid NYS Registered Nurse license.
Certified Case Manager within 3 years of accepting position.
Multi-state RN licensure preferred.
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to HealthNow New York Inc..
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Sun, 26 Aug 2012 07:43:27 GMT