PT Utilization Review Nurse - Melville, NY

<b>At LogistiCare, you have the ability to define your own career journey and enjoy the ride along the way and make possibilities real. Your growth is our objective. Whatever your passion, you’ll have the opportunity to find the career you’re looking for, learn and grow in your role, and make a difference in the lives of others. And you’ll do it alongside colleagues you can count on, in a vibrant work environment, with leadership that puts you first. <br/><br/>Sound like a good career fit? </b>

Melville, NY


<strong><a href="" target="_blank" rel="noopener noreferrer">Who We Are: Transportation &amp; Integrated Health Services</a><br /></strong>Nation&rsquo;s largest manager of non-emergency medical transportation, provides 69+ million rides annually in 39 states and D.C. Supports integrated health care programs, improving care coordination for members and their corresponding providers and hospital networks.<br /><br /><strong>What We Value Most &ndash; YOU<br /><br />Benefits - The Whole Package&nbsp;</strong><br />Medical, Vision, Dental, Disability, EAP, Legal, Voluntary Life Insurance, Group Life &amp; AD&amp;D, Flexible Spend Account, Paid STD &amp; LTD, Vacation &amp; Holidays<br /><br /><strong>Culture - Why You Want to Come to Work Every Day</strong><br />Casual Dress - Business Casual, Relaxing - Comfy Lounge Areas, Excitement -Themed&nbsp; Luncheons, Great Hours &amp; Set Shifts - (Mon. &ndash; Fri.)<br /><br /><strong>View Featured Positions Below OR Check Out <a href=";d=ExternalCareerSite" target="_blank" rel="noopener noreferrer">All&nbsp;Career Journey Opportunities&nbsp;with LogistCare</a></strong>

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Overview: Registered Nurse license required The hours for this position are 28 hours per week maximum Tuesday - Friday 9am-4:30pm. The Utilization Review Nurse will be responsible for reviewing non-emergency medical transportation requests for stretcher, ambulance and wheelchair transport. They will obtain appropriate medical information to make medical determinations and will work closely with LogistiCare staff to assist in quality assurance of these trips. They will develop policies and procedures for the medical UR function.
Responsibilities: <ul> <li>Review all ambulance and stretcher trips to assure appropriate utilization of resources</li> <li>Screen all medical documentation and make decisions based on provided information to determine the most efficient and appropriate method of transport or most appropriate medical provider</li> <li>Work closely with Quality Specialist to ensure all approved trips are entered correctly into EDS system</li> <li>Maintain client confidentiality by compliance with HIPPA guidelines and LogistiCare's confidentiality policy</li> <li>Act as a resource for LogistiCare staff for all medical questions</li> <li>Actively work with the Healthcare Manager and Assistant Director of Operations on overall</li> <li>QA Plan for site-specific operations</li> <li>Make suggestions for and updates policies and procedures as needed</li> <li>Maintains all confidential client information in files</li> <li>Destroys confidential information when appropriate by shredding</li> <li>Participates in in-services as needed or requested by manager</li> </ul>
Requirements: <ul> <li>Competency Statement(s)</li> <li>Communication, Oral - Ability to communicate effectively with others using the spoken word</li> <li>Communication, Written - Ability to communicate in writing clearly and concisely</li> <li>Decision Making - Ability to make critical decisions while following company procedures</li> <li>Interpersonal - Ability to get along well with a variety of personalities and individuals</li> <li>Problem Solving - Ability to find a solution for or to deal proactively with work-related problems</li> <li>Relationship Building - Ability to find a solution for or to deal with customers and co-workers</li> <li>SUPERVISORY RESPONSIBILITIES <ul> <li>None</li> </ul> </li> <li>Education: RN with an active state license preferred</li> <li>Experience <ul> <li>Strong Utilization</li> <li>Review professional background or at least 4 years recent clinical experience strongly preferred</li> </ul> </li> <li>SKILLS &amp; ABILITIES <ul> <li>Exceptional interpersonal skills with excellent written and verbal skills</li> <li>Knowledge of clinical UR and QA, Medicaid, Medicare guidelines and covered services</li> <li>Broad knowledge of health care system including hospital, nursing home and community medical knowledge&nbsp;</li> <li>Computer proficiency with Microsoft Office, Excel, and Access</li> </ul> </li> <li>SUPERVISORY RESPONSIBILITIES <ul> <li>None</li> </ul> </li> <li>PHYSICAL DEMANDS <ul> <li>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.</li> <li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.&nbsp;</li> <li>While performing the duties of this Job, the employee is regularly required to talk or hear.</li> <li>The employee is frequently required to use hands to finger, handle, or feel.</li> <li>The employee is occasionally required to stand, walk, reach with hands and arms and lift.</li> <li>Specific vision abilities required by this job include close vision.</li> </ul> </li> <li>WORK ENVIRONMENT <ul> <li>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.</li> <li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li> <li>Entire work time is conducted in an office environment in a controlled atmosphere building.</li> <li>The noise level in the work environment is usually moderate.</li> </ul> </li> </ul>