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Job Details

CCR Nurse

Company name
Becker Technical Staffing, Inc.

Location
Newark, DE

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Profile

Description

Our client needs a contract to hire resource

to serve as a Clinical Care Review Nurse:

RN

Must have the following:

3 or more years' experience in a related clinical setting (acute/hospital)

Registered Nurse licensed in the state of DE

Excellent oral and written communication skills.

Ability to identify problems and recommend solutions.

Self-directed/Ability to work independently.

Excellent decision making skills.

Excellent time management skills, prioritizing work and meeting timelines.

Ability to advocate for member/member family needs.

Dedicated to meeting the expectations and requirements of internal and external customers.

Obtains continuing education required to maintain professional licensure.

Ability to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer).

The primary purpose of the job is to:

Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse's discretion to process requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.

Company info

Becker Technical Staffing, Inc.
Website : http://www.beckerstaffing.com/

Company Profile
Becker Technical Staffing is widely recognized as an authority for technical, pharmaceutical/healthcare, marketing sciences and financial/accounting talent acquisition. Our woman owned organization is comprised of highly experienced professionals ranging from technical and financial industry leaders to doctorate level clinicians. Our consultants bring specific measurable and quantifiable expertise to a proven talent acquisition process. Becker's track record is impressive and our reputation for success is well earned. Our consultants are trained to provide both contract and direct-hire staffing solutions so you have time to focus on your core business.

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