RN - Case Coordinator

Since 1978 POMCO has been providing its clients with best in class, comprehensive, self-insured professional benefits management solutions. Today we are one of the largest and most progressive Professional Benefits Administrators in the country.  POMCO has an employee friendly culture and competitive benefit and compensation package.

 

Are you interested in taking your nursing career into an exciting new direction?

We are currently looking for an RN Case Coordinator to perform Utilization Review within our

Medical Services Department.

 

Duties include:

?  Pre-certification of inpatient cases and homecare according to corporate, URAC, and industry standards.

?  Perform medical procedure review, ensuring consistency with corporate guidelines and health plan provisions.

?  Case manage large cases to limit cost and liability for clients, fostering quality results, reporting savings as appropriate.

?  Research medical procedures and treatments, recommending procedural changes in accordance with findings and industry standards.

?  Review inpatient and outpatient claims and records as required.

?  Serve as liaison between POMCO, the client, the enrollee, and the provider.

?  Negotiate rates to ensure client savings as opportunities are available.

?  Prepare files for litigation, attend various committee meetings and prepare reports.

?  Additional duties as requested.

 

Requirements include:

?  Registered Nurse with current unrestricted NYS license. Bachelor?s degree desirable.

?  Knowledge of utilization review and level of care in acute care facility.

?  Acute care hospital experience and / or home health care experience.

?  Familiarity with the internet and Microsoft Word programs, including Outlook.

?  Ability to effectively converse and listen to others concerning company matters, health plan and medical issues, using proper written and grammatical skills.   

 

Find out more by visiting our website at: www.pomcoplus.com.