RN - Health Care - Analysts
4 weeks ago
Registered Nurse (Clinical Analyst) - Full Time (Onsite)
Clinix Healthcare is currently seeking a Registered Nurse (Clinical Analyst) to join their team in Dublin, Ohio, 43016.
Clinix Healthcare offers complete medical management services to help ensure benefits are optimally and effectively used by your members. Clinix collaborates with you to make certain quality healthcare is accessed appropriately. We combine our expertise in the traditional clinical review products of Utilization Management, Specialty Case Management, Disability Management, Disease Management and Medical Claims Review. Our services help ensure better clinical outcomes for patients. And we help encourage members to assume more accountability for their health.
Responsible for the Medical Necessity reviews and member education of the Clinical Management Department. Supports management and staff members with adherence to client expectations, URAC Standards, State Regulations and the Quality Management Program. Salary: $34 - $40 per hour
Training: 6 months of extensive paid training.
Shift: Monday - Friday (8 hours a day)
Assists with training of new employees.
• Promotes ongoing staff development/education programs.
• Delegates staffing assignments equitably according to strengths and limitations of staff members.
• Communicates regularly with staff members to provide opportunities for discussion of staff concerns, orientation to new products, procedures or changes in clinical policy/procedures.
• Participates in the quality monitoring of processes and staff.
Oversees clinical management of cases, including evaluation of clinical assessments, care planning, coordination and evaluation of the clinical process.
• Application of clinical management principles across the continuum of care
• Knowledge of various health plans. Assists with processes impact on care outcomes and cost benefit analysis.
• Development of process to promote collaboration with relevant healthcare providers and family members, coordination and delivery of health care services, including the availability of community resources in augmenting the patient’s health care delivery needs.
Provides statistics and analysis for client reports as requested.
• Adheres to Cyber Security policies and procedures and assists with staff compliance monitoring of such.
Facilitates the Clinix Quality Management Program (QMP) throughout the organization:
Supports management and staff member participation in the QMP by participating at any stage of the quality process.
Initiates quality teams and/or participates on quality teams as requested.
Supports data system enhancements by suggesting appropriate modifications to facilitate clinical data collection.
Participates in the functions of the Quality Committee that review complaints, grievances and suggestions for processes change.
Annual review of policy and procedures.
Assists with staff education.
Acts as a liaison to the Medical Director and the physician reviewers.
Coordinates continuing education for the staff.
Other duties, responsibilities and special projects as assigned.
May performs administrative functions in the absence of the CEO.
Bachelor’s or Associate degree in nursing.
Active Ohio Nursing License
At least 1 year of acute nursing care experience.
Extensive knowledge of case management and quality management.
Knowledge of group health insurance and insurance funding methodologies.
Skilled in computer programs such as Microsoft Office features, including Word, Excel, and Outlook.
Excellent writing, oral presentation skills.
Self-starter, problem-solver, creative, energetic.
Excellent telephone skills.
Use of standard office equipment including computers.
May require excessive use of telephonic equipment.
No other abnormal hazards or risks involved.
Medical/Dental Insurance
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