Current jobs related to Nurse Consultant, Full time Day, Regional Office - Atlanta GA United States - Kaiser Permanente
-
Nurse Consultant, Full time Day, Regional Office
2 months ago
Atlanta, United States Kaiser Permanente Full timeJob SummaryThe Nurse Consultant will provide/gather clinical expertise for areas of compliance which involve medical necessity and/or quality concerns. Utilizes clinical expertise to conduct investigations and seek input from other clinical professionals as required. Acts as a liaison, problem-solver, and negotiator to achieve resolution on member requests...
-
Nurse Consultant, Full time Day, Regional Office
4 weeks ago
Atlanta, United States Health eCareers Full timeJob DescriptionJob SummaryThe Nurse Consultant will provide/gather clinical expertise for areas of compliance which involve medical necessity and/or quality concerns. Utilizes clinical expertise to conduct investigations and seek input from other clinical professionals as required. Acts as a liaison, problem-solver, and negotiator to achieve resolution on...
-
Regional Nurse Consultant RN
3 weeks ago
Lewisville, TX, United States StoneGate Senior Living Full timeRegional Nurse Consultant RN StoneGate Senior Living East Texas Region StoneGate Senior Living in Lewisville, TX is hiring a Regional Nurse Consultant RN for out East Texas Region. - -A rewarding career is waiting for you at a great facility that specializes in long-term and rehabilitative care! If you are an experienced -Regional Nurse Consultant RN, we...
-
Regional MDS Nurse Consultant
4 weeks ago
Atlanta, Georgia, United States Advantage Care Group Full timeJob Title: Regional MDS Nurse ConsultantAdvantage Care Group is seeking a highly skilled and experienced Regional MDS Nurse Consultant to join our team. As a key member of our clinical leadership team, you will be responsible for providing technical assistance and training to MDS Coordinators across multiple facilities in Georgia.Key Responsibilities:Consult...
-
RN Circulator, full-time days
12 hours ago
Elko, NV, United States Northeastern Nevada Regional Hospital Full timeNortheastern Nevada Regional Hospital – RN Circulator Who We Are:People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Northeastern Nevada Regional Hospital is a 75-bed facility located in Elko, Nevada. We offer a wide range of healthcare services, including emergency medicine, heart...
-
Regional Infection Preventionist
4 weeks ago
Atlanta, United States Centurion Health Full timeJob DetailsJob Location GA, Atlanta - Atlanta Regional Office - Atlanta, GA Position Type Full-Time Education Level Bachelor's Degree Travel Percentage Up to 25% Job Shift Day Job Category Nursing Professional & Support DescriptionCenturion is proud to be the provider of medical health services to the Georgia Department of Corrections. We are currently...
-
RNFA OR Full Time Days
3 months ago
Palm Springs, CA, United States Desert Regional Medical Center Full timeDesert Regional Medical Center is a 385 bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative , patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint...
-
RNFA OR Full Time Days
1 month ago
Palm Springs, CA, United States Desert Regional Medical Center Full timeDesert Regional Medical Center is a 385 bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative , patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint...
-
Regional Retirement Consultant
2 weeks ago
Atlanta, Georgia, United States Invesco Full timeJob Title: Regional Retirement ConsultantAs a Regional Retirement Consultant at Invesco, you will play a critical role in developing and maintaining Defined Contribution Investment Only (DCIO) business on various retirement platforms. You will work closely with our external sales team to serve as the primary internal sales resource for both prospecting and...
-
Regional Retirement Consultant
1 week ago
Atlanta, Georgia, United States Invesco Full timeJob Title: Regional Retirement ConsultantAbout the Role:As a Regional Retirement Consultant at Invesco, you will play a vital role in developing and maintaining Defined Contribution Investment Only (DCIO) business on various retirement platforms. You will work closely with our external sales team to serve as the primary internal sales resource for both...
-
Regional Sales Consultant
2 weeks ago
Atlanta, Georgia, United States Signode Industrial Group Full timeJob Title: Regional Sales ConsultantAt Signode Industrial Group, we are seeking a highly skilled Regional Sales Consultant to join our team. As a key member of our sales team, you will be responsible for promoting and selling our high-performance packaging systems to customers in your defined territory and industry segment.Key Responsibilities:Sell our...
-
Palm Springs, CA, United States Desert Regional Medical Center Full timeDesert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint...
-
Palm Springs, CA, United States Desert Regional Medical Center Full timeDesert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint...
-
Nursing Officer of the Day-Off
2 weeks ago
Atlanta, Georgia, United States VETERANS HEALTH ADMINISTRATION Full timeJob SummaryThe Nursing Officer of the Day {Off-Tour Nursing Supervisor} (NOD) Registered Nurse (RN) is a critical role in the Veterans Health Administration, responsible for delivering and coordinating safe, efficient, and effective patient care throughout all areas of the facility. As a Nurse II, you will provide care and direct others in the promotion and...
-
Region Chief People Officer, Americas
1 month ago
Atlanta, United States Marsh & McLennan Companies Full timeCompany: Oliver Wyman Company Overview: Oliver Wyman is a global leader in management consulting. With offices in 70 cities across 30 countries, Oliver Wyman combines deep industry knowledge with specialized expertise in strategy, operations, risk management, and organization transformation. The firm has more than 7,000 professionals around the world who...
-
Region Chief People Officer, Americas
1 week ago
Atlanta, United States Marsh McLennan Full timeCompany: Oliver Wyman Description: Oliver Wyman is a global leader in management consulting. With offices in 70 cities across 30 countries, Oliver Wyman combines deep industry knowledge with specialized expertise in strategy, operations, risk management, and organization transformation. The firm has more than 7,000 professionals around the world who work...
-
Region Chief People Officer, Americas
4 weeks ago
Atlanta, United States Marsh McLennan Full timeCompany: Oliver Wyman Description: Oliver Wyman is a global leader in management consulting. With offices in 70 cities across 30 countries, Oliver Wyman combines deep industry knowledge with specialized expertise in strategy, operations, risk management, and organization transformation. The firm has more than 7,000 professionals around the world who work...
-
Patient Safety Coordinator Full Time Days
1 month ago
Palm Springs, CA, United States Desert Regional Medical Center Full timeDesert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint...
-
Patient Safety Coordinator Full Time Days
3 weeks ago
Palm Springs, CA, United States Desert Regional Medical Center Full timeDesert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint...
-
Floating Regional Nurse
3 weeks ago
Adams Center, NY, United States Centers Healthcare Full timeFloating Regional Nurse Centers Health Care is looking to hire a full-time Floating Regional Nurse to routinely consult with our facilities throughout Upstate, NY. The ideal candidate will have at least three to five years prior experience as a Regional Nurse and/or Regional Director of Nursing in a long-term care environment. Summary: The Regional Nurse...
Nurse Consultant, Full time Day, Regional Office
2 months ago
The Nurse Consultant will provide/gather clinical expertise for areas of compliance which involve medical necessity and/or quality concerns. Utilizes clinical expertise to conduct investigations and seek input from other clinical professionals as required. Acts as a liaison, problem-solver, and negotiator to achieve resolution on member requests and appeals. Responsible for reviewing and analyzing audit related reports and providing consultation on non-compliance. Reports to the Director of Risk Management, while working collaboratively with Quality and Patient Safety Teams.
Essential Responsibilities
- Works directly with KPGA Risk Management, KPGA Member Services, and Shared Service Member Services organizations and other clinical and administrative leadership to investigate and facilitate resolution of complex and high profile member requests and appeals.
- Provides/gathers clinical expertise for areas of compliance which involve medical necessity and/or quality concerns. Interprets clinical cases (grievances and appeals including lab values, medical records, and interpretation) and presents appropriate clinical material for Physician review. Reviews member complaints to identify potential quality issues that should be referred to the local Quality Departments.
- Drafts Quality of Care letters to contracted facilities and tracks responses. Provides direct support and consultation on corrective actions developed by departments for areas of non-compliance to ensure the compliance issue(s) is adequately addressed.
- Utilizes clinical expertise to conduct investigations and seek input from other clinical professionals as required. Acts as a liaison, problem-solver, and negotiator to achieve resolution on member requests and appeals.
- Leads and/or represents Regulatory Compliance at routine and ad hoc meetings on specific compliance areas relating to GA state regulations.
- Maintains database and provides all user groups timely notice of updates and implementation timeframes according to the regulations.
- Works with KFHP/KFH, Medical Group departments and Senior Leadership at divisional, regional, and local levels as a consultant with Center of Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), and GA Department of Public Health (GADPH) compliance and develops, implements, tracks, and reports on work plans for correction.
- Participates in the development and implementation of internal audits for CMS, NCQA, GADPH, and State Programs compliance. Coordinates the audit process, including reviewing, analyzing, and reporting findings internally to the Director, Senior Leadership, and to KFHP quality committees.
- Assists in the development of appropriate policies relating to compliance. Participates in the development and implementation of necessary educational programs to ensure all appropriate parties are knowledgeable about their compliance responsibilities on an on-going basis.
- Leads, makes significant contributions, and/or provides technical leadership to high visibility projects to identify and resolve issues of strategic importance to the Standard Unit, Correspondence Center unit and organization. Interfaces regularly with management and KPGA Operations Leaders to produce timely and valuable results.
- Plans and facilitates meetings, as directed. Makes formal presentations to various high-level audiences.
Basic Qualifications:
- Minimum five (5) years experience and knowledge in subject matter area of expertise.
- Graduate of an accredited nursing program.
- Registered Nurse Degree required.
- Registered Professional Nurse License (Georgia) required at hire
- Knowledge of computer skills, data base management, and Microsoft Office.
- Plans and facilitates meetings, as directed. Makes formal presentations to various high-level audiences.
- Excellent interpersonal, verbal, and written communication skills.
- Ability to work with peers in self-managed teams to meet deadlines.
- Demonstrated conflict resolution and mediation skills with ability to secure action from persons outside their supervision.
- Ability to use sound judgment and to handle potentially charged issues independently but with the knowledge and ability to escalate and ask for help when needed.
- Ability to multi-task and manage time in order to perform well on long-term projects while being flexible enough to assimilate short term projects on an on-going basis.
- Able to work in a Labor / Management Partnership environment. May require some travel to the Service Areas and/or Regional offices across the Division. Personal transportation required for local Service Area travel.
- Strong Clinical skills.
- Experience with chart reviews and triaging serious events.
- Bachelors Degree in health retated field.
