Onsite IPCC- /Northside Hospital

Primary Functions/Responsibilities:Responsible for carrying out utilization review, quality review and discharge planning on inpatient admissions including rehabilitation units at core facilities according to policy. The activities will include onsite admission and concurrent review for inpatient admissions, discharge planning, identification of patients for case management, communication with case managers, home care reviewers, Social Workers, members and providers, quality improvement reviews, and education of the member/family, provider and hospital staff. Achieves desired utilization and quality outcomes and promotes high customer satisfaction to the population served.Required Competencies and Skills:- Excellent interpersonal/communication skills, including telephone skills.- Demonstrated analytical and problem solving skills.- Ability to build effective working relationships with physicians and their staff, hospitals/SNF units, vendors, and other departments.- Excellent planning and time management skills including the ability to handle multiple tasks at any given time.- Demonstrated ability to be assertive and express ones opinion even if it is conflicting with others.Required Education, Experience and Training:- Unrestricted current Registered Nurse (RN) licensure or Licensed Clinical Social Worker (LCSW) licensure in the state of Georgia required or documentation to show intent to seek license.- Valid Georgia drivers license.- At least two (2) years of experience in utilization or case management, discharge planning and quality improvement in a managed care setting.- Working knowledge of all federal, state, local and regulatory requirements.- Functional knowledge of computers.- Experience with managed health care delivery including Medicare.- Complete a Customer Service Assessment*.Preferred Education, Experience and Training:- Three (3) years of clinical nursing experience preferably in a complex area such as critical care. - BSN preferred.- Customer service aptitude demonstrated through Customer Service Assessment*. Additional Information Reference Code: 939633 Position Type: Full Time