|Location:||Little Rock, AR|
|Employment Type:||Full Time|
|Department:||QSource of Arkansas|
|Description:||Are you a nurse searching for a career away from the hospital? If so, come join the Qsource Arkansas team. Qsource Arkansas is a healthcare consulting organization serving to advance the quality of healthcare for Arkansans. We are committed to assisting healthcare providers and organizations make innovative and sustainable improvements that result in positive healthcare outcomes.|
We offer an excellent salary and benefit package, that includes health, dental and vision insurance, and a generous retirement program. We also offer a casual work environment and a flexible schedule because we understand your personal life is as important as your professional life. If you're dedicated and ready to work for an organization that cares about you, we have an opening for a Arkansas licensed RN to work full-time, 40 hours per week. This position is responsible for performing all required case review functions for assigned cases as defined in the Arkansas Medicaid Manual.
|Duties:||• Duties include, but are not limited to, initial review of each case and administration/ management of the entire process through completion. |
• Manage assigned caseload in accordance with case tracking standards, timeliness, and procedures set forth in Arkansas Medicaid Manual and QSource Review Procedures.
• Perform Medicaid prior authorization review functions.
• Initiate and facilitate all required referrals to Therapist and/or physician reviewers including documenting appropriate findings.
• Monitor Arkansas Therapy Services Review System for assigned caseload.
• Obtain Therapy Review Manager, Executive Director, Therapist, and/or Medical Directorate support as needed to complete case review functions.
• Communicate with QSource internal and external customers as appropriate to complete case review functions.
|Qualifications:||• Licensure or certification; Registered Nurse (RN) required.|
• Experience in outpatient pediatric and/or adult case review, medical record documentation, Medicaid reimbursement procedures, and billing practices preferred.
• Previous coding experience desired.
• Background in UR and/or QI case management experience preferred.
• One (1) year previous clinical experience.
• Experience using basis statistics helpful.
• Experienced Case Reviewer including case intake, medical record review, customer contact, communication and coordination of the case review and resolution process.
• Maintains a customer driven process.
• Experience in electronic health information management.
• Produces high quality completed work products.
• Knowledge of medical record, ICD-9-CM and CPT coding principals.
• Knowledge of medical Utilization Review (UR) and Quality Improvement (QI) concepts.
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