Job Description

Candidates need to live in the following areas:

1. Fairfax, Falls Church, Annandale Vienna,Ashburn
2. Herndon, Sterling, Reston
3. Arlington, Alexandra

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

Determines medical necessity/ appropriateness Facilitates optimal outcomes Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy Optimize total costs Implementation and evaluation of policy based on usage and program directives Educate/empower colleagues at all levels to enable decision making at most appropriate level

Position Summary:

Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively
manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

Duties:

Determines medical necessity/ appropriateness
Facilitates optimal outcomes
Identifies and follow through with continuous quality/ compliance opportunities . May also include identification of aberrance's and initiation of corrective action
Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy
Optimize total costs
Implementation and evaluation of policy based on usage and program directives
Educate/empower colleagues at all levels to enable decision making at most appropriate level

Experience:

Required Qualifications:
• RN with current unrestricted Virginia state licensure required.
• 3 years clinical experience (for example med surg or behavioral health)
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
• Effective communication skills, both verbal and written.
Preferred Qualifications:
• Managed Care experience, Case Management experience in an integrated model
• 5 years clinical practice experience
• Bilingual

Education:
• RN with VA current unrestricted Virginia state licensure required.
• Associate's or Bachelor's in Nursing What days & hours will the person work in this position? List training hours, if different. M-F 8-5InterSources

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