ERP International, LLC (www.erpinternational.com) is seeking multiple RN Case Managers to support the Mike O’Callaghan Federal Medical Center, Nellis Air Force Base, in Las Vegas, NV.

We will relocate you!

Schedule:
Normal schedule is Monday – Friday: 7:30am – 4:30pm, with a one hour lunch (40 hours/week)
No Holidays/No Weekends
 
Job Specific Details and Tasks:

• Must have the knowledge and skills to effectively apply the following core case management functions: a) Assessment: Identification of patients for case management; comprehensive collection of patient information and medical status; and continued evaluation of an established plan of care; b) Planning: Collaboration with the patient, family/caregiver, primary provider and other members of the health care team for developing an effective plan of care; c) Facilitation: Care coordination and communication among all involved parties; d) Advocacy: Support for the patient and family/caregivers to ensure identified education and appropriate, timely care is received.
• Must have knowledge of medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]), and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission (TJC), and Clinical Practice Guidelines (CPGs).
• Must have a working knowledge of computer applications/software to include Microsoft Office programs (Outlook, Excel, PowerPoint, Publisher and Access, Skype), and internet familiarity is required.
• Must have a working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding; and McKesson (InterQual) and/or Milliman Care Guidelines
• Must have experience in Patient Advocacy, Patient Privacy, and Customer Relations.
• Must be able to perform prospective, concurrent, and retrospective reviews to justify medical necessity for requested medical care and to aid in collection and recovery from multiple insurance carriers
• Must be skillful and tactful in communicating with people who may be physically or mentally ill, uncooperative, fearful, emotionally distraught, and occasionally dangerous.
• Must be able to collect clinical data from inpatient and outpatient sources; provide documentation for appeals or grievance resolution; apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations; apply problem-solving techniques to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way
• Must possess organization, problem-solving and communication skills to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way.