Milliman Utilization Review Jobs in Usa

Position Overview:

The Hopsice Registered Nurse is responsible for pain management, symptom control in the delivery of care to hospice patients, as established by the plan of care, the interdisciplinary team, attending physician and Hospice Medical Director.

Schedule: Full-Time visits Monday - Friday with Saturday and Sunday on-call rotation

Territory: Montgomery, Elmore, Coosa, Autauga, Bullock, Pike, Tallapoosa, Chambers, Lee, Macon and Russell communities

Position Overview:

- Ensures the timely and adequate delivery of hospice services to the terminally ill patient and their family, operating within the plan of care as established by the hospice team and attending physician.
- Assesses the total needs of the patient/family during regularly scheduled and after hour home visits; Documents: assessment, identified problems, nursing interventions, goals, and outcomes of interventions.
- Coordinates total patient/family hospice care under the supervision of the Director and with the interdisciplinary team, the attending physician, and other providers; documents such coordination.
- Collaborates with the interdisciplinary team in the development, review and revision of the clinical component of patient/family plan of care, including exchange of information, review of problems, assessing effectiveness of interventions and documenting outcomes.
- Ensures continuity of care between patient/family, team members, ancillary providers, long term and inpatient care facilities, and the attending physician.
- Communicates patient/family/caregiver needs, ongoing nursing assessment, interventions, goals and outcomes through the interdisciplinary process.
- Provides and documents continuing education of the hospice concept of care to patients and their families/caregivers.
- Supervises the delivery of patient care provided by Hospice Aides, Licensed Practical Nurses; ensuring compliance with the established plan of care and completing required documentation of supervision.
- Facilitates the delivery of hospice services to patients residing in long term care facilities, documenting joint coordination of care with facility professional staff, and attending facility care plan meetings as appropriate.
- Participates in on-call rotation for delivery of care after office hours, on weekends, and holidays.
- Provides ongoing monitoring of patient appropriateness for hospice services and completes required documentation for certification and recertification.
- Interfaces with the patient/family/caregiver, the hospice team, other health care providers in a respectful, professional and courteous manner.
- Maintains compliance with Medicare Conditions of Participation, Joint Commission standards, Hospice and Professional Standards of Nursing Practice, and agency specific policies and procedures.
- Supports community education of hospice for growth and development of the program.
- Dispenses medical supplies in a cost effective manner, as dictated by the plan of care and patient needs.
- Participates in quality improvement, utilization review, and infection control activities as requested.
- Attends appropriate inservices, and participates in continuing education.
- Ensures accurate and current patient chart information by timely and consistent documentation.
- Maintains a professional, well-groomed appearance, adhering to the agency dress code.
- Maintains sound privacy and security practices and prevents privacy or security breaches. If breach occurs, takes corrective action.

Aveanna Healthcare Offers:

- 401(k) with match
- Health, Dental and Vision Benefits for employees at 30+ points
- Tuition Discounts and Reimbursement
- PTO, Sick Time, and Paid Holidays

Qualifications:

- Current license as a Registered Nurse in the State of Alabama
- Minimum of one (1) year medical/surgical experience. Hospice/Home Health experience preferred.
- Valid CPR
- Current, valid Alabama drivers license.

HHH

As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Notice for Job Applicants Residing in California

Notice for Job Applicants Residing in Florida

Position Overview:

The Hopsice Registered Nurse is responsible for pain management, symptom control in the delivery of care to hospice patients, as established by the plan of care, the interdisciplinary team, attending physician and Hospice Medical Director.

Schedule: Full-Time visits Monday - Friday with Saturday and Sunday on-call rotation

Territory: Montgomery, Elmore, Coosa, Autauga, Bullock, Pike, Tallapoosa, Chambers, Lee, Macon and Russell communities

Position Overview:

- Ensures the timely and adequate delivery of hospice services to the terminally ill patient and their family, operating within the plan of care as established by the hospice team and attending physician.
- Assesses the total needs of the patient/family during regularly scheduled and after hour home visits; Documents: assessment, identified problems, nursing interventions, goals, and outcomes of interventions.
- Coordinates total patient/family hospice care under the supervision of the Director and with the interdisciplinary team, the attending physician, and other providers; documents such coordination.
- Collaborates with the interdisciplinary team in the development, review and revision of the clinical component of patient/family plan of care, including exchange of information, review of problems, assessing effectiveness of interventions and documenting outcomes.
- Ensures continuity of care between patient/family, team members, ancillary providers, long term and inpatient care facilities, and the attending physician.
- Communicates patient/family/caregiver needs, ongoing nursing assessment, interventions, goals and outcomes through the interdisciplinary process.
- Provides and documents continuing education of the hospice concept of care to patients and their families/caregivers.
- Supervises the delivery of patient care provided by Hospice Aides, Licensed Practical Nurses; ensuring compliance with the established plan of care and completing required documentation of supervision.
- Facilitates the delivery of hospice services to patients residing in long term care facilities, documenting joint coordination of care with facility professional staff, and attending facility care plan meetings as appropriate.
- Participates in on-call rotation for delivery of care after office hours, on weekends, and holidays.
- Provides ongoing monitoring of patient appropriateness for hospice services and completes required documentation for certification and recertification.
- Interfaces with the patient/family/caregiver, the hospice team, other health care providers in a respectful, professional and courteous manner.
- Maintains compliance with Medicare Conditions of Participation, Joint Commission standards, Hospice and Professional Standards of Nursing Practice, and agency specific policies and procedures.
- Supports community education of hospice for growth and development of the program.
- Dispenses medical supplies in a cost effective manner, as dictated by the plan of care and patient needs.
- Participates in quality improvement, utilization review, and infection control activities as requested.
- Attends appropriate inservices, and participates in continuing education.
- Ensures accurate and current patient chart information by timely and consistent documentation.
- Maintains a professional, well-groomed appearance, adhering to the agency dress code.
- Maintains sound privacy and security practices and prevents privacy or security breaches. If breach occurs, takes corrective action.

Aveanna Healthcare Offers:

- 401(k) with match
- Health, Dental and Vision Benefits for employees at 30+ points
- Tuition Discounts and Reimbursement
- PTO, Sick Time, and Paid Holidays

Qualifications:

- Current license as a Registered Nurse in the State of Alabama
- Minimum of one (1) year medical/surgical experience. Hospice/Home Health experience preferred.
- Valid CPR
- Current, valid Alabama drivers license.

HHH

As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Notice for Job Applicants Residing in California

Notice for Job Applicants Residing in Florida

Position Overview:

The Hopsice Registered Nurse is responsible for pain management, symptom control in the delivery of care to hospice patients, as established by the plan of care, the interdisciplinary team, attending physician and Hospice Medical Director.

Schedule: Full-Time visits Monday - Friday with Saturday and Sunday on-call rotation

Territory: Montgomery, Elmore, Coosa, Autauga, Bullock, Pike, Tallapoosa, Chambers, Lee, Macon and Russell communities

Position Overview:

- Ensures the timely and adequate delivery of hospice services to the terminally ill patient and their family, operating within the plan of care as established by the hospice team and attending physician.
- Assesses the total needs of the patient/family during regularly scheduled and after hour home visits; Documents: assessment, identified problems, nursing interventions, goals, and outcomes of interventions.
- Coordinates total patient/family hospice care under the supervision of the Director and with the interdisciplinary team, the attending physician, and other providers; documents such coordination.
- Collaborates with the interdisciplinary team in the development, review and revision of the clinical component of patient/family plan of care, including exchange of information, review of problems, assessing effectiveness of interventions and documenting outcomes.
- Ensures continuity of care between patient/family, team members, ancillary providers, long term and inpatient care facilities, and the attending physician.
- Communicates patient/family/caregiver needs, ongoing nursing assessment, interventions, goals and outcomes through the interdisciplinary process.
- Provides and documents continuing education of the hospice concept of care to patients and their families/caregivers.
- Supervises the delivery of patient care provided by Hospice Aides, Licensed Practical Nurses; ensuring compliance with the established plan of care and completing required documentation of supervision.
- Facilitates the delivery of hospice services to patients residing in long term care facilities, documenting joint coordination of care with facility professional staff, and attending facility care plan meetings as appropriate.
- Participates in on-call rotation for delivery of care after office hours, on weekends, and holidays.
- Provides ongoing monitoring of patient appropriateness for hospice services and completes required documentation for certification and recertification.
- Interfaces with the patient/family/caregiver, the hospice team, other health care providers in a respectful, professional and courteous manner.
- Maintains compliance with Medicare Conditions of Participation, Joint Commission standards, Hospice and Professional Standards of Nursing Practice, and agency specific policies and procedures.
- Supports community education of hospice for growth and development of the program.
- Dispenses medical supplies in a cost effective manner, as dictated by the plan of care and patient needs.
- Participates in quality improvement, utilization review, and infection control activities as requested.
- Attends appropriate inservices, and participates in continuing education.
- Ensures accurate and current patient chart information by timely and consistent documentation.
- Maintains a professional, well-groomed appearance, adhering to the agency dress code.
- Maintains sound privacy and security practices and prevents privacy or security breaches. If breach occurs, takes corrective action.

Aveanna Healthcare Offers:

- 401(k) with match
- Health, Dental and Vision Benefits for employees at 30+ points
- Tuition Discounts and Reimbursement
- PTO, Sick Time, and Paid Holidays

Qualifications:

- Current license as a Registered Nurse in the State of Alabama
- Minimum of one (1) year medical/surgical experience. Hospice/Home Health experience preferred.
- Valid CPR
- Current, valid Alabama drivers license.

HHH

As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

Notice for Job Applicants Residing in California

Notice for Job Applicants Residing in Florida

POSITION SUMMARY/RESPONSIBILITIES

The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/ plan f care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.

EDUCATION/EXPERIENCE

Bachelor’s degree in Nursing is highly preferred. Three to five years nursing experience required (as a Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred.

LICENSURE/ CERTIFICATIONS

Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two years of placement. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.

POSITION SUMMARY/RESPONSIBILITIES

At the front door of University Health, this role serves to screen patients needing placement in acute or observation beds for the purposes of correct status determinations, and the coordination of appropriate diversions to home or other level of care more appropriate for the services needed to be rendered. This position requires assertive clinical acumen and communication skills for serving in the liaison roles with medical staff, nursing, and patients and families.

EDUCATION/EXPERIENCE

Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. National certification (e.g. CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred. Three years recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. Must complete a Clinical Documentation Improvement Course within specified time of hire date.

LICENSURE/CERTIFICATION

Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is preferred. Case Manager Certification (CCM or ANCC) is highly desirable.

POSITION SUMMARY/RESPONSIBILITIES

The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/ plan f care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.

EDUCATION/EXPERIENCE

Bachelor’s degree in Nursing is highly preferred. Three to five years nursing experience required (as a Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred.

LICENSURE/ CERTIFICATIONS

Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two years of placement. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.

POSITION SUMMARY/RESPONSIBILITIES

At the front door of University Health, this role serves to screen patients needing placement in acute or observation beds for the purposes of correct status determinations, and the coordination of appropriate diversions to home or other level of care more appropriate for the services needed to be rendered. This position requires assertive clinical acumen and communication skills for serving in the liaison roles with medical staff, nursing, and patients and families.

EDUCATION/EXPERIENCE

Graduation from an accredited school of nursing with current RN licensure in the State of Texas, BSN preferred. National certification (e.g. CCRN, RNC, CEN, CNOR, OCN, ANCC, CAN, CPAN, CFRN, etc.) in related field is preferred. Three years recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. Must complete a Clinical Documentation Improvement Course within specified time of hire date.

LICENSURE/CERTIFICATION

Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National certification in related field is preferred. Case Manager Certification (CCM or ANCC) is highly desirable.

POSITION SUMMARY/RESPONSIBILITIES

The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/ plan f care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.

EDUCATION/EXPERIENCE

Bachelor’s degree in Nursing is highly preferred. Three to five years nursing experience required (as a Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred.

LICENSURE/ CERTIFICATIONS

Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two years of placement. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.

POSITION SUMMARY/RESPONSIBILITIES

The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/plan of care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.

EDUCATION/EXPERIENCE

Bachelor’s degree in Nursing is highly preferred. Three to five years nursing experience required (as a Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred.

LICENSURE/ CERTIFICATIONS

Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two years of placement. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.
Remote working/work at home options are available for this role.

POSITION SUMMARY/RESPONSIBILITIES

The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/plan of care for a patient within the acute episode of care. He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs.

EDUCATION/EXPERIENCE

Bachelor’s degree in Nursing is highly preferred. Three to five years nursing experience required (as a Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred.

LICENSURE/ CERTIFICATIONS

Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two years of placement. Current American Heart Association, Basic Cardiac Life Support and/or Health Care Provider card preferred.