| |
|
Career, Jobs and Resume Groups Forum Index » Jobs U.S.A. » US-DE: Newark-Inpatient Care Nurse Cnsultnt
Page 1 of 1
|
| Author |
Message |
| JobCircle.Com |
 Posted: Sat Jun 07, 2008 1:46 am |
|
|
|
Guest
|
**************************************************************
JobCircle.com is a regional job board serving all industries
and occupations in the PA, NJ, DE, NY, MD, and DC areas.
We offer a regional job board, online learning, and regional
job fair events for jobseekers who live in our areas of focus.
To Learn More:
Job Board: http://www.JobCircle.com?source=ng
eLearning: http://www.JobCircle.com/courseware?source=ng
Job Fairs: http://JobCircleJobFairs.com?source=ng
**************************************************************
Job Title: Inpatient Care Nurse Cnsultnt
Job Location: DE: Newark
Pay Rate: Open
Job Length: full time
Start Date: 2008-06-06
Company Name: Aetna
Contact: HR
Phone: email only please
Fax: email only please
Description: Inpatient Care Nurse Cnsultnt Job Group: Health Care Requisition #: 23853 Location: Newark, DE Travel: 50 - 75% FLSA Status: Exempt Full/Part Time: Full Time Supervisory: No Compensation Pay Opportunity: $49,590.00 - $59,900.00 Bonus Potential: Variable %
Requirements ABOUT OUR COMPANY We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
JOB MISSION SUMMARY The Nurse Consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. More specifically, the inpatient care process includes: obtaining necessary information from providers and facilities concerning the care being provided to members; the assessment of a members clinical condition and ongoing medical services and treatments to determine medical appropriateness; guide the setting for medical intervention to achieve optimum length of stay for members; the early identification of continuing care needs to facilitate discharge to the appropriate setting and discharge planning & coordination. This position will work at home and be responsible for on-site clinical review at acute care medical hospitals located in Sussex County Delaware
RESPONSIBILITIES: Initial Assessment - Reviews and evaluates patients clinical history and current medical condition to identify needed medical services - Authorize and coordinate the required services, in accordance with the benefit plan - Determines appropriate levels of coverage for inpatient stay by using clinical judgment and applying M&R Care Guidelines, or Interqual Criteria to meet the members needs - Makes appropriate referrals to the Plan Medical Directors - Proactive and predictive identification and appropriate screening for referrals to alternative healthcare programs e.g., disease management, case management - Conducts clinical assessments of members care needs and determines approaches to meeting needs either through Aetna, the members benefits plan or external programs and services Development and Implementation of Care Plans - Obtain and document medical history relevant to this admission - Based on review of the clinical information gathered, determines the appropriate plan of care to meet the needs of the patient - Critically review medical record to compare care plan to actual plan - Identifies expected discharge plan - Evaluates and identifies health care
service delivery using clinical knowledge in determining the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services - Communicate with physician - offer alternative care settings if appropriate - Timely documentation of clinical evaluation in comparison to guidelines - Identifies potential alternatives based on member benefits, other resources, local infrastructure, and individual needs - Coordinate discharge plans to home or alternative levels of inpatient care - Promotes communication, both internal and externally to enhance effectiveness of medical management services (e.g., Physicians, as well as member, family, and health care team members respectively) - Applies care management concepts to complex issues and problem solving techniques in order to promote optimum patient outcomes, e.g., evaluates the patients needs, and recommends appropriate cost effective alternatives - Work with Aetna Case Manager on cases that are open to Case Management - Focus on targeted cases with avoidable variation from guidelines Enhancement of Medical Appropriateness & Quality of Care - Application a
nd/or interpretation of appropriate clinical criteria and guidelines, policies, procedures and regulatory standards while assessing Members needs to ensure appropriate administration of benefits - Interprets relevant medical policy/benefits determination to an identified case - Provides the appropriate level of intervention to facilitate coordination of care - Identifies members with co-morbidities who may benefit from intervention at the individual or population based level - Advocates for patients to the full extent of existing health care coverage and programs - Interprets medical policy and guidelines and applies clinical judgment to make appropriate coverage decisions in unique situations - Identifies and escalates quality of care issues through established channels Monitoring, Evaluation and Documentation of Care - Work with Aetna Case Manager on cases that are open to Case Management - Administers the hospital care, processes in compliance with various laws and regulations, URAQ and/or NCQA standardswhile adhering to company policy and procedures - Evaluates, periodically, the members progress in meeting the inpatient care plan and discharge goals, and revises and coordinat
es plan with the hospital discharge planner, the attending physician, and the patient/family when appropriate - Engages in discussion with attending physician if care plan is in jeopardy without demonstrated need - Questions illogical sequence and appropriateness of care - Develop approach to removing barriers and use UR departments to facilitate adherence to care plan - Consults with supervisors and/or Medical Directors to overcome barriers to meeting inpatient care and discharge planning goals and objectives; confers with the Medical Director electronically and presents cases at Medical Director rounds - Ensures accurate and complete documentation of required information that to meet risk management, regulatory, and accreditation requirements - Protects the confidentiality of member information and adheres to company policies regarding confidentiality Drivers license and reliable transportation required for travel. REQUIRED SKILLS: - 2-5 years clinical practice experience required, preferably in acute care, in a hospital setting. - 2 years managed care experience preferred. - Licensed Nurse with current unrestricted state license (e.g., LPN, LVN or RN) - Strong customer service
skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. - Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. - Ability to effectively participate in a multi-disciplinary team including internal and external participants. - Initiative, innovation, flexibility, decisiveness and creativity. - Self directed and motivated to achieve positive outcomes for members. - Excellent/Proven clinical assessment skills with ability to make good decisions and exercise sound clinical and professional judgment as well as manage multiple priorities.
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position. We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
Please refer to Job code aetna-23853 when responding to this ad.
For FASTEST PROCESSING of your resume, please visit http://www.jobcircle.com/classifieds/1355735.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.
************************************************************** |
|
|
| Back to top |
|
| |
|
Page 1 of 1
All times are GMT
The time now is Thu Feb 09, 2012 10:54 am
|
|
|