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HealthHelp Registered Nurse

HealthHelp

This is a Full-time position in Dallas, TX posted June 7, 2021.

HealthHelp

Registered Nurse VIRTUAL CAREER DAY

Wednesday June 9, 2021 – 9am – 1pm

Join us to chat with Hiring Managers and Recruiters about Registered Nurse opportunities!

About Us:

HealthHelp – A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

Clinical Triage Nurse

  • Answers calls from Injured Workers (IW) and immediately determines the severity of the injury
  • Immediately beginning first aid at the onset of a call
  • Gathers basic information about the IW
  • Identifying urgent/emergent situations
  • Utilize medical guidelines to assess IW
  • Directing the IW to the most appropriate level of care and facility
  • Educating the IW on self-treatment and next level of care
  • Adheres to all appropriate privacy, security and confidentiality policies and procedures.
  • Performs other duties as assigned.

Job Requirements:

Clinical Utilization Management Nurse Reviewer

  • Has a working knowledge of regulations and accreditation requirements by state and specific markets and applies appropriate LCD/NCD, HealthHelp or Client’s medical policy guidelines
  • Performs utilization review of cases to determine if the request meets criteria
  • Facilitates resolution of escalated cases that may require special handling
  • Performs clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times
  • Collects and enters confidential information ensuring the highest level of confidentiality in all areas
  • Refers cases to a Physician Reviewer or Specialty Medical Director per guidelines
  • Collaborates with client personnel to resolve customers concerns
  • Appropriately identifies and refers quality issues to UM Leadership
  • Assist Physician Reviewer Medical Directors as necessary to ensure timeframe compliance
  • Maintains written documentation according to HealthHelp’s documentation policy
  • Ensures consistency in implementation of policy, procedure and regulatory requirements in collaboration with Nursing Management
  • Keeps current with regulation changes as provided by Compliance Department and  Nursing Management

We look forward to chatting with you!