Job Information
Adecco US, Inc. *Quality Management Nurse Consultant in Woonsocket, Rhode Island
Adecco is currently assisting a local client, recruiting for Quality Management Registered Nurse Consultant working from home. For instant consideration, Apply Now!
Requires an RN with unrestricted active license
3 years of clinical experience required- Managed Care/Medicare experience required.( This experience is not negotiable )
Schedule: M-F 8-5
Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. Requires an RN with unrestricted active license
Reviews documentation and evaluates the necessity of provider requests, but applying national and state based criterion, thus conducting Medical Necessity Review.
Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
Commands a comprehensive knowledge of complex delegation arrangements, contracts ,clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
Condenses complex information into a clear and precise clinical picture while working independently
Candidates must meet the following requirements to be considered:
Requires an RN with unrestricted active license
3 years of clinical experience required- Managed Care/Medicare experience required.( This experience is not negotiable )
Strong proficiency in MS WORD and Excel
Click on apply now for instant consideration!
This employer requires all employees, temporary labor, consultants, and contractors to be fully vaccinated against COVID-19 by their start date, subject to approved medical or religious exemptions.
The anticipated wage for this position is between $36.20 and $39.11. Hourly wage may depend upon experience, education, geographic location and other factors.
Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.
Pay Details: $36.20 to $39.11 per hour
Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.
Equal Opportunity Employer/Veterans/Disabled
To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.adeccousa.com/candidate-privacy
The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.