Utilization Clinical Nurse Utilization Clinical Nurse …

Cognizant
in Phoenix, AZ, United States
Permanent, Full time
Be the first to apply
Competitive
Cognizant
in Phoenix, AZ, United States
Permanent, Full time
Be the first to apply
Competitive
Utilization Clinical Nurse
Utilization Clinical Nurse

Job Profile Summary

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.

Education/Experience:

Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.

Licenses/Certifications: Current California State RN license

Responsibilities:

Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options

Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes

Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients . Provide patient and provider education

Facilitate member access to community based services

Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan

Actively participate in integrated team care management rounds

Identify related risk management quality concerns and report these scenarios to the appropriate resources.

Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience

Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Direct care to participating network providers

Perform duties independently, demonstrating advanced understanding of complex care management principles.

Participate in case management committees and work on special projects related to case management as needed

IND123

Employee Status : Contractor

Shift : Day Job

Travel : No

Job Posting : Nov 12 2019

About Cognizant
Cognizant (Nasdaq-100: CTSH) is one of the world's leading professional services companies, transforming clients' business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 193 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @Cognizant.
Cognizant is recognized as a Military Friendly Employer and is a coalition member of the Veteran Jobs Mission. Our Cognizant Veterans Network assists Veterans in building and growing a career at Cognizant that allows them to leverage the leadership, loyalty, integrity, and commitment to excellence instilled in them through participation in military service.
Close
Loading...