OMS RN - Prior Authorization

Nurse care managers will develop and implement a targeted plan of care to decrease avoidable Emergency Department usage for MaineCare members. Partner with hospitals to provide ongoing education to members and provider community on selected members. Work with the Care Management Unit staff members to monitor work queues and complete assigned tasks. Attend and participate in bi-weekly hospital rounds to discuss complex cases and determine appropriate outcomes. Collect data and prepare records, reports and statistical information to assist in the evaluation and measurement of wellness programs and ED Care Management Initiative Project. Develop plans of care for clinically complex members. Attend conferences regularly for wellness initiatives available within the community. Outreach members in the community via phone, mail, and fax. Perform other duties and responsibilities as may be assigned from time to time.
RequirementsSix (6) year combination of education, training, and/or experience. Must be a Licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the State of Maine and possess three (3) years of progressively responsible experience in the field of nursing and/or in the delivery of health care services.
Change Healthcare is an Equal Opportunity Employer. Employment at Change Healthcare is based upon your individual merit and qualifications. We don't discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, marital status, protected veteran status or disability, genetic characteristic, or any other characteristic protected by applicable federal, state or local law. We will also make all reasonable accommodations to meet our obligations under the Americans with Disabilities Act (ADA) and state disability laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability. Please visit Equal Employment Opportunity Posters provided by OFCCP here.
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