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 HealthAssess all the requests for medical services requiring clinical review against Quantum Health adopted clinical review criteriaCommunicate with patient, provider, facility, and internal work groups regarding outcome of requestsBe clinical resource for all Quantum health work groupsCoordinate 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 criteriaResearch status of vague or questionable procedures and present to the Medical Director for reviewIdentify potential high risk/high cost cases and chronic condition cases and refer to the appropriate case management teamIdentify care coordination opportunities for patients being admitted for elective surgical proceduresPrepare letters explaining non-covered requestsDocument Interventions in the databaseDirect 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 neededFacilitate the discharge planning process during pre-service review and coordinate with other clinical work teamsNotify Medical Director of all requests you are unable to certify within specified time framesProvide monitoring and oversight of non-clinical staff activities and be available to non-clinical staff during CHC business hoursMaintain a working knowledge of all CHC workflowsOther duties as assigned by the Director of Clinical ServicesSo 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 licenseMinimum of five years clinical experienceExperience in health management desiredStrong ability to communicate effectively with patients, employer groups, and physiciansEffective problem solvingComputer literacyPossess excellent time management skillAbility to make decisions that are timely and well thought out and that achieve results consistent with business goals and organizational cultureAbility to work independently and self-directed with limited need for day to day supervisionStrong customer service skillsPossess excellent verbal and written communication skillsAnd if you join us, we hope that you'll work hard.

Have fun. Reap the benefits.On-site fitness facilityPaid maternity and paternity leave for births and adoptionsDomestic partner benefitsFun Room with a pool table, ping pong table and air hockeySerenity Room for relaxation and meditationFrequently catered lunchesFree beverages, snacks and fresh-popped popcorn ALWAYSYes, 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 - 2 years 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...