Utilization review nurse Jobs in New Orleans, LA

Description

Absolute Care offers concierge health services using a risk-bearing, PCP-driven care model. We treat the most clinically complex and vulnerable members of the communities we serve, many of whom suffer from behavioral health, substance use, and SDoH challenges. We use population health management tools to employ a holistic approach to caring for the highest utilizers of healthcare services in our comprehensive care centers and in the community. Absolute Care tends exclusively to the needs of the top four to six percent of the population who persistently represent a disproportionate amount of unnecessary utilization and cost, regardless of whether they are engaged with other PCPs. In our more than 20 years of service, Absolute Care has focused on fulfilling the needs of this population. And we have consistently achieved unprecedented outcomes by addressing medical and psychosocial issues, in addition to the hardships of life that can exacerbate chronic health conditions and complicate access to care.

Our Values :

• Accountability - We have the integrity to do what we say we will do
• Caring - The needs of our team and members matter
• Trust - Our members can rely on us
• Teamwork - We act together as one inclusive group

Description :

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with health plans and different providers / care teams to help ensure inpatient bed days and associated discharge / transitional care plans are appropriate. The Utilization Review Nurse provides clinical review for different healthcare services requiring authorization- including acute inpatient, skilled nursing facility, acute rehab, home nursing as well as others. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity and appropriateness of treatment setting by utilizing the applicable policies and guidelines. Utilizes decision making and critical thinking skills in the review and determination of coverage for medically necessary health care services. Is part of a team that accountable for facilitating and providing care coordination services and associated quality outcomes for patients across the continuum of discharge planning and transitional care. Collaborates with different teams to develop and / or implement comprehensive discharge care plans based on assessment of member's clinical and social needs.

Experience

Our employeesare offered the following benefits

AbsoluteCare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.