- Registered Nurse (RN) with an active, current, unrestricted license in Rhode Island in good standing
- Minimum four (4) years’ relevant clinical experience with general nursing exposure to Utilization Management to include pre-authorization, utilization review, concurrent review, discharge planning, Case Management w/review, and/or skilled nursing facility reviews.
- Minimum two (2) years of experience in a Grievances and Appeals OR Case Management-related setting
- Intermediate Ability to create, review, and interpret treatment plans.
- Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions.
- Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9/10 coding.
- Intermediate Knowledge of community, state and federal laws and resources.
- Intermediate Knowledge of CMS regulations and Medicare Rules.
Licenses and Certifications:
- Candidate will be a Registered Nurse (RN)
- Ideal candidate will have additional licenses or certifications
- Required Intermediate Microsoft Excel Proficient in Microsoft Outlook applications, including Word, Excel, Power Point and Outlook
- Required Intermediate Microsoft Outlook
- Required Intermediate Microsoft Word
- Required Beginner Microsoft PowerPoint
- Required Intermediate Experience with general Healthcare Management Systems
- Ability to use proprietary healthcare management system
- Seven (7) years’ relevant experience
- Experience in a Grievances and Appeals Unit or Department
- BSN Degree or Certification as a Case Manager
- One (1) to two (2) years’ experience in an acute care clinical setting (Medical and/or Behavioral Health).
- Two (2) years’ experience in Managed care experience with significant experience working in a setting like an inpatient hospital or partial hospital, Residential BH or Substance Use Disorder services, Community Mental Health Organization or other relevant facility or program.
- Judgment and Decision Making
- Gets Results
- Collaboration and Teamwork
- Business Awareness
- Customer Focus
Job Specific Competencies:
- Attention to Detail
- Influencing & Negotiation
- Planning & Organizing
- Problem Solving & Analysis
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at email@example.com.
Neighborhood is an EOE M/F/D/V and an E-Verify Employer