• Managed Care Staffers
  • $72,090.00 -100,130.00/year*
  • Downers Grove , IL
  • Healthcare - Nursing
  • Full-Time
  • 1200 Norfolk St

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Seeking Experienced Full-Time Temp-to-hire UM/Care Coor, RNs


Our client, a large physician group located in Downers Grove, IL has some immediate staffing needs experienced full-time UM/Care Coor RNs.
Key Duties: Perform concurrent review and transition planning on medical patients: Determine medical necessity by application of criteria (MCG and/or InterQual) per UM Dept Policy and specific Health Plan guidelines. Recommend an increase or decrease in level of care/equipment/service based upon medical condition and physician orders. Refer all services that do not meet established criteria, to the Medical Director. Notify all parties of Medical Director Determinations, and communicate alternate service options when indicated. Through the discharge planning process, helps identify members who have ongoing case management needs, and refers these members to the Case Management team for outreach.

Qualified candidates need prior experience with discharge planning, transition care, and disease management. Also, need prior experience with MCG and/or InterQual guidelines \"across the continuum of care.\" Candidates with only prior Authorization /referral experience are not sufficient for this client. You must have all the following experience:


Clinical experience from working in a hospital 2-3 years in order to know how a patient should be progressing in prep for discharge and understand possible barriers that may prevent a patient from being discharged
Must know the type of interaction needed to manage a patient in the hospital in order to move them along the continuum of care for discharge
Must know how to apply MCG or InterQual guidelines or apply variances when needed
Know what constitutes a need for Medical Director review
Know how to provide recommendations/alternatives for care vs keeping the patient in the hospital when a different level of care would be more appropriate
How to collaborate with the hospital, home healthcare or skilled nursing facility in order to ensure everything is in place for the patient prior to them being discharged from the hospital.
This position is primarily in an office setting. Coordinating healthcare services is the key element of this position. This is a full-time temporary to hire position Monday-Friday from (8:30am-5:00pm) daily.


Qualified candidates need prior experience with discharge planning, transition care, and disease management. Also, need prior experience with MCG and/or InterQual guidelines \"across the continuum of care.\" Candidates with only prior Authorization /referral experience are not sufficient for this client. You must have all the following experience:


Clinical experience from working in a hospital 2-3 years in order to know how a patient should be progressing in prep for discharge and understand possible barriers that may prevent a patient from being discharged
Must know the type of interaction needed to manage a patient in the hospital in order to move them along the continuum of care for discharge
Must know how to apply MCG or InterQual guidelines or apply variances when needed
Know what constitutes a need for Medical Director review
Know how to provide recommendations/alternatives for care vs keeping the patient in the hospital when a different level of care would be more appropriate
How to collaborate with the hospital, home healthcare or skilled nursing facility in order to ensure everything is in place for the patient prior to them being discharged from the hospital.

Must be an Illinois licensed RN


Associated topics: asn, cardiothoracic, domiciliary, infusion, neonatal, nurse rn, recovery, registered nurse, staff nurse, surgery

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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