Rn Team Coordinator – Clinical Review: 108860 Br
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Posted by: Sentara on Dec 04, 2018


Location:

Virginia Beach, VA

Job Description:

Overview
Optima Health is hiring a Registered Nurse (RN) Team Coordinator for the
Clinical Review Team in Virginia Beach, VA.
The instrumental leader in this role will provide responsibility, accountability and leadership for the daily operations of the Clinical Review team including the coordination of work, quality and service. The Clinical Review Team performs all post-service reviews, assists with updating and maintaining claims policies, assists Business Systems Integration (BSI) teams with claims processing, provides review for appeals and provides coding expertise to the entire organization. Assists with Clinical Care Services (CCS) policy changes and operationalizing changes as a result of coverage decisions.
Minimum BSN degree required, previous supervisory experience and at least 3 years of case management. Coding experience required.
Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.
As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission "to improve health everyday." This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support -every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.
Sentara Benefits:
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits , CLICK HERE!
Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!
Other
For Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM or RN-BC). For other service lines, certification based on specialty area required within one year of eligibility. BLS (if in a clinical setting).
Strong coding background required.
Keyword: RN, Registered Nurse, Team Leader, Team Coordinator, Supervisor, Coding, Clinical Review, Health Plan, Claims
Equal Opportunity Employer

Responsibilities
Assumes responsibility, accountability and leadership for the daily operations including coordination of work, quality, and service. First line supervisor in the Department of Medical Care Management for assigned site/function. Facilitates the work of assigned team members. Provides a leadership role in ongoing case manager competency assessment, needs identification and educational offerings. Provides educational services to the Medical Care Management staff . Participates in the work activities of assigned teams and provides case management services as needed.

Qualifications
Education Level
RN-Bachelor's Level Degree
Experience
Required: Case Management - 3 years
Preferred: Supervisory - Previous experience
License
Required: Registered Nurse
Preferred: Basic Life Support
Skills
Required: Communication, Critical Thinking, Service Orientation

HR. Website URL:

http://www.sentaracareers.com/career-opportunities/

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About Sentara Healthcare

Sentara Healthcare is one of the most progressive and integrated health care organizations in the nation, located mainly in Southeast Virginia and Northern North Carolina with additional sites in Charlottesville, Covington, Harrisonburg and Woodbridge, VA. Sentara operates more than 100 care giving sites, including 12 acute care hospitals including 7 in Hampton Roads, 1 in Northern Virginia and 2 in the Blue Ridge Region, 1 in Southwestern Virginia and 1 in Northeastern North Carolina, outpatient care facilities, nursing centers, assisted living centers, advanced imaging centers and about 380 primary care and multi-specialty physicians. Sentara also offers a full range of award-winning health coverage plans, home health and hospice services, physical therapy and rehabilitation services, including Nightingale - the region’s first air ambulance service. Sentara Healthcare is an acknowledged leader in patient safety and quality innovation. Founded in 1888 as the Retreat for the Sick in Norfolk, Virginia, Sentara has ranked for more than a decade among the nation's top integrated healthcare systems by Modern Healthcare magazine and is the #1 most integrated health care system for two consecutive years. We invite you to share our Vision. To be the healthcare of choice in the communities we serve.

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