Clinical Nurse Specialist
1 week ago
The Utilization Review Nurse is responsible for performing prospective and retrospective reviews of post-acute care services to ensure that WellSky's population receives medically necessary services in the appropriate setting, with the appropriate provider, and at the appropriate level of care.
Key Responsibilities:- Perform initial prior authorization review of post-acute care services applying guideline criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination.
- Authorize post-acute care services in compliance with contractual agreements, health plan guidelines and medical necessity criteria.
- Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively.
- Successfully complete the Interrater Reliability Testing to ensure consistency of review and application of criteria.
- Make benefit determinations about appropriate levels of care using clinical guidelines.
- Coordinate benefits and transitions between various areas of care.
- Consult with the Medical Director as needed for complex cases.
- Apply clinical expertise when discussing case with internal and external Case Managers and Physicians.
- Follow all Standard Operating Procedures in end-to-end management of cases.
- Obtain clinical information to assess and expedite reviews as necessary.
- Participate in team meetings, education discussions and related activities.
- Maintain compliance with Federal, State and accreditation organizations.
- Identify opportunities for improved communication or processes.
- Works on a variety of special projects and assumes other duties as assigned.
- Active RN license.
- 5+ years of clinical nursing experience.
- RN Compact License highly preferred.
- Experience in utilization review, case management and/or managed care.
- MCG/ Interqual or other criteria-based applications.
- General understanding of managed care guidelines and impact on services.
- Graduate of an accredited school of nursing.
- Minimum of 1-2 years of utilization management experience, case management, managed care regulations; or any combination of education and experience, which would provide an equivalent background required.
- Able to pass federal and state required criminal / abuse background checks and drug screen.
- Computer skills including but not limited to MS Office, MS Excel, and Clinical / Operational Software.
WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference.
WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law.
WellSky is proud to be a drug-free workplace.
Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates.
Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky:
- Excellent medical, dental, and vision benefits.
- Mental health benefits through TelaDoc.
- Prescription drug coverage.
- Generous paid time off, plus 13 paid holidays.
- Paid parental leave.
- 100% vested 401(K) retirement plans.
- Educational assistance up to $2500 per year.
-
Clinical Nurse Specialist
4 weeks ago
Overland Park, Kansas, United States College Park Family Care Full timeJob Title: Licensed Practical NurseWe are seeking a highly skilled and compassionate Licensed Practical Nurse to join our team at College Park Family Care. As a Licensed Practical Nurse, you will play a vital role in providing high-quality patient care and contributing to the success of our healthcare team.Responsibilities:Manage the efficient flow of...
-
Clinical Care Specialist
1 week ago
Overland Park, Kansas, United States Curana Health Full timeJob SummaryThe Clinical Care Specialist will administer direct patient care services within the Post-Acute Care setting. This role requires a strong clinical background and excellent communication skills to effectively coordinate care with collaborating physicians and other disciplines.Key Responsibilities Conduct clinical interventional and episodic direct...
-
Clinical Nurse Specialist
2 weeks ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob Title: Clinical NurseAt The University of Kansas Health System, we are seeking a skilled Clinical Nurse to join our team. As a Clinical Nurse, you will play a vital role in delivering high-quality patient care and ensuring the well-being of our patients.Job Summary:The Clinical Nurse will be responsible for providing comprehensive care to patients with...
-
Clinical Nurse Specialist
3 weeks ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob Title: Clinical NurseWe are seeking a skilled Clinical Nurse to join our team at The University of Kansas Health System. As a Clinical Nurse, you will play a vital role in delivering high-quality patient care in a behavioral health setting.Key Responsibilities:Provide thorough and timely documentation of patient data, therapeutic interventions, and...
-
Clinical Education Specialist
1 week ago
Overland Park, Kansas, United States Bethesda Health Full timeJob SummaryAs a Clinical Education Specialist at Bethesda Health, you will be responsible for developing and implementing orientation programs for new employees, focusing on regulatory issues and company values. You will also conduct in-service programs based on needs assessment, state surveys, and introduction of new products and technology. Additionally,...
-
Clinical Care Transition Specialist
2 weeks ago
Overland Park, Kansas, United States Option Care Enterprises, Inc. Full timeClinical Transition SpecialistThe Clinical Transition Specialist is a seasoned sales professional who utilizes sales techniques to promote Option Care products and services to patients transitioning from healthcare facilities. They are responsible for educating patients, their families, and facility staff on the benefits of our services.Key...
-
Clinical Quality Program Specialist
4 days ago
Overland Park, Kansas, United States Elevance Health Full timeThe Clinical Quality Program Specialist plays a pivotal role in supporting projects and enhancing quality improvement activities and programs for Elevance Health.Key responsibilities include developing and maintaining project plans and schedules, ensuring timely delivery of project objectives, and contributing to the integration of quality into the overall...
-
Clinical Nurse Specialist
1 week ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob SummaryThe Clinical Nurse ensures that all clinical care is delivered in a manner that meets or exceeds goals and expectations for clinical outcomes, quality assurance standards, and patient satisfaction.The RN gauges the behavioral health patients' psychiatric state, collaborates with a multi-disciplinary team to support each patients' care plan,...
-
Clinical Nurse Specialist
4 weeks ago
Overland Park, Kansas, United States College Park Family Care Full timeJoin Our Team as a Licensed Practical NurseWe are seeking a skilled Licensed Practical Nurse to join our team at College Park Family Care. As a member of our healthcare team, you will play a vital role in providing high-quality patient care and contributing to the success of our practice.About the RoleThis is a fantastic opportunity for a dedicated and...
-
Clinical Nurse Specialist
4 weeks ago
Overland Park, Kansas, United States College Park Family Care Full timeJoin Our Team as a Licensed Practical NurseWe are seeking a skilled Licensed Practical Nurse to join our team at College Park Family Care. As a member of our healthcare team, you will play a vital role in providing high-quality patient care and contributing to the success of our practice.About the RoleThis is a fantastic opportunity for a dedicated and...
-
Travel Nurse Position in Wichita, Kansas
3 weeks ago
Overland Park, Kansas, United States Travel Nurse Source Full timeER/Trauma Registered Nurse Job OpportunityWe are currently seeking a qualified ER/Trauma Registered Nurse to join our team at Travel Nurse Source. This is a fantastic opportunity to work with a reputable healthcare staffing agency and gain valuable experience in a fast-paced ER/Trauma unit.Job Details:Location: Wichita, KansasShift: HR Nights...
-
Oncology Nurse Specialist
1 week ago
Overland Park, Kansas, United States Research Medical Center Full timeUnlock Your Potential as an Oncology Nurse SpecialistAt Research Medical Center, we're committed to delivering exceptional care to our patients. As an Oncology Nurse Specialist, you'll play a vital role in providing comprehensive cancer services from diagnosis to treatment and survivorship care.Our team is dedicated to creating a supportive and inclusive...
-
Nurse Specialist
21 hours ago
Overland Park, Kansas, United States AdventHealth Full timeNursing Opportunities at AdventHealth Shawnee MissionWe are seeking a compassionate and skilled Registered Nurse to join our team at AdventHealth Shawnee Mission, a leading healthcare provider in Kansas. As a Hybrid Registered Nurse, you will play a vital role in delivering high-quality patient care and contributing to a positive patient experience.About the...
-
Clinical Nurse
4 days ago
Overland Park, Kansas, United States The University of Kansas Health System Full timeJob SummaryThe University of Kansas Health System seeks a skilled Clinical Nurse to join our Behavioral Health team. As a Clinical Nurse, you will play a vital role in delivering high-quality patient care and ensuring the well-being of our patients.Key ResponsibilitiesProvide thorough and timely documentation of patient data, therapeutic interventions, and...
-
Clinical Nutrition Specialist
2 days ago
Overland Park, Kansas, United States Brookdale Senior Living Full timeOverviewBrookdale Senior Living is a leading provider of senior living communities, dedicated to enhancing the lives of our residents. As a Clinical Nutrition Specialist, you will play a vital role in ensuring the nutritional well-being of our residents, working collaboratively with our exceptional team to provide exceptional care.ResponsibilitiesDevelop and...
-
Clinical Nurse Coordinator MedSurg Specialist
1 month ago
Overland Park, Kansas, United States Research Medical Center Full timeAbout the RoleWe are seeking a highly skilled Clinical Nurse Coordinator to join our team at Research Medical Center. As a Clinical Nurse Coordinator, you will play a vital role in ensuring the delivery of high-quality, patient-centered care and coordination of all functions in the unit/department during the designated shift.Key ResponsibilitiesAssist with...
-
Medical Office Specialist
1 month ago
Overland Park, Kansas, United States Saint Luke's Health System Full timeMedical Office Specialist OpportunitySaint Luke's Health System is seeking a Medical Office Specialist to support our Cardiovascular Clinic team. As a key member of our team, you will play a vital role in ensuring patient confidentiality and maintaining a professional environment.Key Responsibilities:Answer and direct phone calls in a timely and professional...
-
Nurse Specialist
5 days ago
Overland Park, Kansas, United States HCA MidAmerica Health Full timeJob Summary:The Nurse Specialist coordinates and delivers high-quality, patient-centered care in accordance with the nature and specific requirements of the department, and consistent with the scope and standards of practice for the relevant state and specialty.In collaboration with medical providers and other members of the care team, the RN provides...
-
Overland Park, Kansas, United States Overland Park Regional Medical Center Full timeJob SummaryThe Clinical Nurse Coordinator (CNC) plays a vital role in ensuring high-quality patient-centered care and coordination of all functions in the Neuro Trauma Unit. In collaboration with the management team, the CNC directs, monitors, and evaluates nursing care, serving as a resource person for staff and modeling a commitment to the organization's...
-
Anesthesiology Specialist
5 days ago
Overland Park, Kansas, United States Anesthesia Associates of Kansas City Full timeAnesthesia Associates of Kansas City is seeking a skilled Anesthesiology Specialist to join their team. The ideal candidate will be a Certified Registered Nurse Anesthetist with experience in hospital-based anesthesia care. Responsibilities include providing professional, clinical, and technical competencies in the assigned unit or department, educating...