Registered Nurse (Clinical Analyst) at Olga Magyar, Ltd.
Dublin, OH 43010
About the Job
Registered Nurse (Clinical Analyst) - Full Time (Onsite)
Clinix Healthcare is currently seeking a Registered Nurse (Clinical Analyst) to join their team in Dublin, Ohio, 43016.
Clinix Healthcare offers complete medical management services to help ensure benefits are optimally and effectively used by your members. Clinix collaborates with you to make certain quality healthcare is accessed appropriately. And it’s provided at an appropriate cost. We combine our expertise in the traditional clinical review products of Utilization Management, Specialty Case Management, Disability Management, Disease Management and Medical Claims Review. Our services help ensure better clinical outcomes for patients. And we help encourage members to assume more accountability for their health.
About the Job:
Responsible for the Medical Necessity reviews and member education of the Clinical Management Department. These responsibilities include management of program outcomes. Supports management and staff members with adherence to client expectations, URAC Standards, State Regulations and the Quality Management Program. Also performs functions of Utilization Review and /or Case Management.
Salary: $34 - $40 per hour
Training: 6 months of extensive paid training.
Shift: Monday - Friday (8 hours a day)
Job Duties:
A. Clinical Management:
1. Co-ordinates processes with clinical and non-clinical personnel:
• Assists with hiring of new employees.• Assists with training of new employees.• Promotes ongoing staff development/education programs.• Delegates staffing assignments equitably according to strengths and limitations of staff members.• Communicates regularly with staff members to provide opportunities for discussion of staff concerns, orientation to new products, procedures or changes in clinical policy/procedures.• Promotes a positive and efficient working environment.• Participates in the quality monitoring of processes and staff.
2. Coordinate with CEO in establishing annual department goals and objectives.
3. Oversees clinical management of cases, including evaluation of clinical assessments, care planning, coordination and evaluation of the clinical process.
• Application of clinical management principles across the continuum of care• Ability to assess all physical and psychological factors that could affect the patient• Knowledge of various health plans. Assists with processes impact on care outcomes and cost benefit analysis.• Development of process to promote collaboration with relevant healthcare providers and family members, coordination and delivery of health care services, including the availability of community resources in augmenting the patient’s health care delivery needs.
4. Performs individual case reports
5. Establishes and maintains effective working relationships with all clients, providers and internal departments.
6. Provides statistics and analysis for client reports as requested.
• Number of cases• Outcomes of managed cases• Timeliness• Clinical documentation• Client expectations
7. Maintains client and patient confidentiality at all times.
8. Adheres to Cyber Security policies and procedures and assists with staff compliance monitoring of such.
B. Facilitates the Clinix Quality Management Program (QMP) throughout the organization:
1. Supports management and staff member participation in the QMP by participating at any stage of the quality process.
2. Initiates quality teams and/or participates on quality teams as requested.
3. Supports data system enhancements by suggesting appropriate modifications to facilitate clinical data collection.
4. Participates in the functions of the Quality Committee that review complaints, grievances and suggestions for processes change.
5. Ensures that URAC Standards and other regulations are met.
a. Annual review of policy and procedures.
b. Identifies processes that require review and potential revision.
c. Maintains current updates on Standards/regulations.
d. Assists with staff education.
6. Ensures compliance with State-specific Regulations.
7. Acts as a liaison to the Medical Director and the physician reviewers.
8. Coordinates continuing education for the staff.
C. Other duties, responsibilities and special projects as assigned.
D. May performs administrative functions in the absence of the CEO.
Education & License:
- Bachelor’s or Associate degree in nursing.
- Active Ohio Nursing License
Experience & Skills:
- At least 1 year of acute nursing care experience.
- Extensive knowledge of case management and quality management.
- Knowledge of group health insurance and insurance funding methodologies.
- Skilled in computer programs such as Microsoft Office features, including Word, Excel, and Outlook.
- Excellent writing, oral presentation skills.
- Self-starter, problem-solver, creative, energetic.
- Strong interpersonal skills.
- Ability to work in a team environment.
- Works independently in a highly organized manner.
- Excellent telephone skills.
- Ability to manage and complete multiple tasks.
- Use of standard office equipment including computers.
Physical Demand:
- Light work.
- Requires sitting most of the day.
- May require excessive use of telephonic equipment.
- May require lifting at times.
- Works in well-lighted, heated, pleasant and air-conditioned surroundings.
- No other abnormal hazards or risks involved.
Benefits:
- 401K
- Medical/Dental Insurance
- Vacation/Sick Leave/ Paid Birthday Off
Please submit your resume via the ‘Apply now’ button.
We are an Equal Opportunity Employer!