Clinical Nurse Evaluator
Paradigm Healthcare LLCHouston, TX, USjob_description.job_card.variable_days_ago
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job_description.job_card.job_descriptionMust possess a current, unencumbered, active license to practice as a nurse. 2 years’ experience with admissions process at a skilled nursing facility, subacute, rehab, or other health care facility. Significant experience and strong skills using Point Click Care software. Significant experience and strong computer literacy skills (Microsoft Outlook, Microsoft Office suite, and other online platforms). Recent long-term care experience required. Experience making independent decisions when circumstances warrant such action. Self-motivated and self-directed : possesses the ability to work independently. Excellent written and verbal communication skills. Demonstrates leadership, organizational skills, and ability to maintain a positive and professional attitude. Ability to establish and maintain working relationships with multiple and varied people and organizations. Medical Insurance Dental Insurance Vision Insurance Health Savings Account Life Insurance Flexible / Non Accrual PTO Professional Development Assistance
Job Description
Job Description
Paradigm Healthcare is looking to hire a skilled and motivated Clinical Nurse Evaluator to join our amazing team!
Reports to
Director of Referral Management
Summary / Objective
In keeping with our organization’s goals, then Clinical Nurse Evaluator will manage the clinical components of the referral process and oversees the five stages of the referral process.
Job Duties
- Utilizes Clinical Determination Tool to determine clinical acceptance.
- Oversee the denial process.
- Identifies referral care needs, high-cost medications, DME, wound care, etc.
- Understands the referral process including policy, procedures, assessments, and communication requirements.
- Participates in daily CRM calls.
- Maintain a thorough knowledge of the facilities services, clinical capabilities, and physician relationships.
Required Education, Experience, and Skills
Benefits
Position Type and Expected Hours of Work
This position supports healthcare facilities that operate every day. Although this is generally a Monday through Friday position, there will be scheduled times of work on the weekends and holidays.
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Clinical Nurse • Houston, TX, US