HealthHelp
Registered Nurse VIRTUAL CAREER DAY
Wednesday June 9, 2021 – 9am – 1pm
Join us to chat with Hiring Managers and Recruiters about Registered Nurse opportunities!
About Us:
HealthHelp – A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.
Clinical Triage Nurse
- Answers calls from Injured Workers (IW) and immediately determines the severity of the injury
- Immediately beginning first aid at the onset of a call
- Gathers basic information about the IW
- Identifying urgent/emergent situations
- Utilize medical guidelines to assess IW
- Directing the IW to the most appropriate level of care and facility
- Educating the IW on self-treatment and next level of care
- Adheres to all appropriate privacy, security and confidentiality policies and procedures.
- Performs other duties as assigned.
Job Requirements:
Clinical Utilization Management Nurse Reviewer
- Has a working knowledge of regulations and accreditation requirements by state and specific markets and applies appropriate LCD/NCD, HealthHelp or Client’s medical policy guidelines
- Performs utilization review of cases to determine if the request meets criteria
- Facilitates resolution of escalated cases that may require special handling
- Performs clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times
- Collects and enters confidential information ensuring the highest level of confidentiality in all areas
- Refers cases to a Physician Reviewer or Specialty Medical Director per guidelines
- Collaborates with client personnel to resolve customers concerns
- Appropriately identifies and refers quality issues to UM Leadership
- Assist Physician Reviewer Medical Directors as necessary to ensure timeframe compliance
- Maintains written documentation according to HealthHelp’s documentation policy
- Ensures consistency in implementation of policy, procedure and regulatory requirements in collaboration with Nursing Management
- Keeps current with regulation changes as provided by Compliance Department and Nursing Management
We look forward to chatting with you!