RN Patient Care Coord - Quality Monitoring

CareSource Dayton, OH
Role and Responsibility:

* Execute quality monitoring reviews as defined by the Quality Monitoring Policy and Procedure and Quality Monitoring Desk Reference

* Assist in identifying and evaluating any risk areas and provide input to the development of process improvements

* Perform quality monitoring procedures, education to staff to define issues

* Educate or assist in educating the results of the quality monitoring audit to the behavioral and medical management and physician reviewer staff in a timely basis

* Knowledgeable in the prospective, retrospective and concurrent review process of inpatient admissions, outpatient procedures, homecare services and durable medical equipment

* Pursue development opportunities, including external and internal training, and share information gained with co-workers

* Assist with developing and executing a new employee onboarding plan

* Perform any other job related instructions, as requested


Education / Experience:

* Completion of an accredited registered nursing (RN) degree program is required

* Minimum of three (3) years medical/surgical acute care experience is required

* Two (2) years of medical management experience is preferred

* Medicaid/Medicare or Commercial experience is preferred

Required Competencies / Knowledge / Skills:

* Intermediate level of proficiency with Microsoft Word, Excel and Access is required

* Basic level of proficiency with data entry and internet skills

* Communication Skills; written and verbal

* Ability to work independently and within a team environment

* Attention to detail

* Familiarity of the healthcare field

* Proper grammar usage

* Time management skills

* Proper phone etiquette

* Customer service oriented

* Decision making/problem solving skills

* Strong organizational skills

* Change resiliency

Licensure / Certification:

* Current, unrestricted Registered Nurse (RN) license in state(s) of practice is required

Working Conditions:

General office environment; may be required to sit/stand for long periods of time

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