Field Nurse - PSG Global Solutions Careers : Job Details

Apply now and our proprietary system will quickly have you in front of a live recruiter. The Opportunity Description We're looking for a Field Nurse, working in Insurance industry in Fairport, New York, United States.

• Collaborates with interdepartmental teams and external stakeholders, if necessary, to assist in the development of Person-Centered Service Plan.
• Clarifies benefits, policies, and procedures for current members, providers, and community-based agencies.
• Assesses, plans and implements care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care.
• Identifies social service programs; including financial, psychosocial, community and state supportive services available to augment the need for LTSS services.
• Refers appropriate cases to governmental agencies (e.g. APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit (SIU) or designated internal/external entity.
• Communicates with all internal and external stakeholders to obtain the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• May be required to attend Fair Hearings with Medical Director relating to specific cases.
• Attends departmental meetings, as required.
• Works independently, as well as collaboratively, with members and internal/external stakeholders, resulting in improved member health.
• Manages complex assignments.
• Serves as a positive role model to others in the department.
• Adheres to all Corporate and Departmental policies and ensures all regulatory requirements such as DOH, CMS, Medicaid, and accreditation requirements such as NCQA, URAC and HEDIS functionalities are met or exceeded.

Our Client Our client is a fast-growing industry-recognized staffing firm. Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent. With 20+ years' experience and growth. Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services. Working to bring top talent together with premier organizations. Big enough to have great opportunities. Small enough to care about finding the right one for you. It'sabout relationships based on mutual interest. The results are low turnover, long-lasting partnerships and growth. Want to work for a company invested in your success? Experience Required for Your Success

• RN with valid and current NYS Nursing Licensure
• A minimum of four years clinical experience in ambulatory care, community health or home health setting
• Valid NYS driver's license required
• Long Term Support Services (LTSS) or Managed Long-Term Care (MLTC) UAS field RN experience preferred.
• Excellent written and verbal communication skills.
• Excellent computer skills and use of measurement/criteria following NYS guidelines.
• Working knowledge of Microsoft Office applications (Word, Excel)
• Strong interpersonal skills.
• Understanding of the basic Utilizations Management aspects of the department
• Provide efficient, effective, and appropriate documentation
• Ability to take on broader responsibilities
• May be asked to participate in some committees
• Broad understanding of multiple areas, including but not limited to UM and CM, Fair Hearings and Appeals/Grievances, within three months of working in position.
• Demonstrates ability to handle complex assignments, difficult members and highly visible issues.
• Must have ability to travel.
• Ability to travel across regions.

What Do You Think? Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible?