Pre Certification Nurse
Quantum Health - Columbus, OH

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Quantum Health is an award-winning company that's experiencing explosive growth! As one of the Best Places to Work in Columbus, we're looking for some of the best nurses in (or around) Columbus.

Right now, we are looking for LPN's and RN's to work as a Pre-Certification Nurse in our
Care Coordination Center. In this role, you will have the following responsibilities:
  • Promote the mission and core values of Quantum Health
  • Assess all the requests for medical services requiring clinical review against Quantum Health adopted clinical review criteria
  • Communicate with patient, provider, facility, and internal work groups regarding outcome of requests
  • Be clinical resource for all Quantum health work groups
  • Coordinate health management services in an effort to provide integrated health services for each patient and provider benefit and health information to patients, care givers, providers and facilities so they are able to make informed health decisions.
  • Clinical review of all requests for health services or treatment that require assessment against clinical criteria
  • Research status of vague or questionable procedures and present to the Medical Director for review
  • Identify potential high risk/high cost cases and chronic condition cases and refer to the appropriate case management team
  • Identify care coordination opportunities for patients being admitted for elective surgical procedures
  • Prepare letters explaining non-covered requests
  • Document Interventions in the database
  • Direct out of network requests to in network providers to ensure members secure the optimum desired benefits and negotiate fee arrangements with out of network providers as needed
  • Facilitate the discharge planning process during pre-service review and coordinate with other clinical work teams
  • Notify Medical Director of all requests you are unable to certify within specified time frames
  • Provide monitoring and oversight of non-clinical staff activities and be available to non-clinical staff during CHC business hours
  • Maintain a working knowledge of all CHC workflows
  • Other duties as assigned by the Director of Clinical Services
So do you have what it takes to work at Quantum Health? This role requires the following qualifications:
  • Licensed as a Registered or Licensed Practical Nurse with an unrestricted license
  • Minimum of five years clinical experience
  • Experience in health management desired
  • Strong ability to communicate effectively with patients, employer groups, and physicians
  • Effective problem solving
  • Computer literacy
  • Possess excellent time management skill
  • Ability to make decisions that are timely and well thought out and that achieve results consistent with business goals and organizational culture
  • Ability to work independently and self-directed with limited need for day to day supervision
  • Strong customer service skills
  • Possess excellent verbal and written communication skills
And if you join us, we hope that you'll work hard. Have fun. Reap the benefits.
  • On-site fitness facility
  • Paid maternity and paternity leave for births and adoptions
  • Domestic partner benefits
  • Fun Room with a pool table, ping pong table and air hockey
  • Serenity Room for relaxation and meditation
  • Frequently catered lunches
  • Free beverages, snacks and fresh-popped popcorn ALWAYS
Yes, there's also the "normal" medical/dental/vision insurance, flexible spending accounts, life insurance, 401(k), paid time off and more.

If you're an exceptional care-giver who's looking to work for a company that will take exceptional care of you, then please apply. Stat!

Quantum Health - 20 months ago - save job - - block
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About this company
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Founded in Columbus in 1999, Quantum Health is an award-winning care management and health improvement company serving the healthcare needs...