**RN Healthcare Coordinator** **Description** **Position Summary** : The Health Care Coordinator is responsible for precertification of selected services or procedures, concurrent review, and retrospective review. The Health Care Coordinator interacts regularly with health care staff, providers, and physicians with some interaction with patients and their families; assists in the development of policy relating to precertification and utilization management; acts as an advocate in coordinating and gaining access to needed health care services; participates in quality improvement activities and interacts with claims administrator personnel to exchange required certification information. **Qualifications** : 1. Registered Nurse with active and unrestricted license to practice in the State of Missouri and multi-state licensure when applicable. 2. Minimum three years nursing experience in an acute care or relevant setting with evidence of the ability to make sound nursing judgment. 3. Minimum one year experience in a utilization review/case management setting; desirable. 4. Excellent verbal, written and interpersonal communication skills are essential with accurate spelling, grammar, and documentation skills. 5. Evidence of ability to work cooperatively, tactfully and assertively with medical providers and others. 6. Ability to work independently with minimal supervision. 7. Proficient in basic computer skills including Microsoft Windows and Office along with the ability to access the internet to effectively navigate web-based programs and to do research. **Responsibilities** : 1. Certifies services based upon policy and information received from attending physician and/or other providers using established medical criteria. Refers all cases that do not meet established criteria to physician review. 2. Requests certification reviews as appropriate. 3. Follows up to cases for appropriate discharge. 4. Manages referrals and request for information as required by specific health plan. 5. Maintains current knowledge of related healthcare Federal and State regulations. 6. Performs all activities within the scope of licensure and acts within the scope of Federal and State Laws and programs. 7. Maintains knowledge of cultural differences including socioeconomic factors, cultural traditions and spiritual beliefs, and researches these differences as needed via libraries, Internet and/or professional journals. 8. Establishes an effective working relationship with the patient/family, provider and payer. Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve. We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world. Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at www.conduent.com . **Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the \"Submit\" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first:** **click here to access or download the form** at **.** **Job** Service Delivery Healthcare **Primary Location** United States-Missouri-Jefferson City **Organization** Government **Unposting Date** Ongoing**Req ID:** 19005672 Associated topics: hospice, intensive care, neonatal, nurse, nurse clinical, nurse rn, recovery, surgery, tcu, transitional
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.