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Weslaco, Texas, United States Pediatrix Medical Group Full timeJob SummaryPediatrix Medical Group is seeking a highly skilled Neonatal Nurse Practitioner to join our team of dedicated healthcare professionals. As a Neonatal Nurse Practitioner, you will provide high-quality, patient-centered care to critically ill newborns and their families.ResponsibilitiesProvide comprehensive care to neonates in a level II and III...
Nurse II
2 months ago
Under the direct supervision of the Utilization Review Nurse Manager, the Utilization Review Nurse will be responsible for reviewing and evaluating individual records, individual service plans, patient assessments, and documentation related to Medicaid waiver programs. The nurse will conduct face-to-face interviews with individuals enrolled in various programs to determine service justification and make service authorization decisions.
Key Responsibilities:- Conduct desk reviews of required documentation for Medicaid waiver programs and Community Attendant Services (CAS)
- Participate in onsite reviews of individuals identified in the random sample
- Review, evaluate, and document services provided to aged and disabled persons and individuals with intellectual disabilities
- Make service authorization decisions on difficult, complicated, and/or targeted cases
- Conduct quality assurance reviews and quality improvement studies to evaluate compliance with Medicaid program service requirements, state rules, regulations, policies, and procedures
- One year's experience in the provision of direct services to persons with an intellectual disability
- Knowledge of nursing health care laws, rules, standards, and regulations, medical diagnoses and procedures, community health and nursing care principles, quality management, utilization management, and Medicaid waiver program standards
- Written and verbal communication skills necessary to consult, teach, and provide clear and concise directions and reports
This position works collaboratively with other Utilization Review nurses and regional staff to implement an effective statewide Utilization Review program. The nurse will work under the general supervision of the Utilization Review Nurse Manager, with moderate latitude for use of initiative and independent judgment.
