Clinical RN Advisor


Des Peres, MO

What you'll be doing

Clinical RN Advisor who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS coverage guidelines review criteria. Manage network participation, care with speciality networks and care with DME providers and transfers to alternative levels of care using your knowledge of benefit plan design. Recommend services for members utilizing care alternatives available within the community and nationally. Identify potentially unnecessary services, care delivery settings and recommend alternatives if appropriate by analyzing clinical protocols. Examine clinical programs information to identify members for specific case management and / or disease management activities or interventions by utilizing established screening criteria. Conduct admission review, post-discharge calls and discharge planning. Consistently model and inspire high levels of integrity, lives up to commitments, and takes responsibility for the impact of ones actions. Meet established expectations and takes responsibility for achieving results; encourage others to do the same. Connect meaningfully with customers to build emotional engagement and customer advocacy. Simplify complexity and integrates internal efforts to deliver an optimal customer experience. Effectively leverage resources to create exceptional outcomes, embraces change and constructively resolves barriers and constraints.

What your background should be

Active RN license required. Ability to be licensed in multiple states without restrictions. Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting. Valid driving license and/or dependable transportation necessary (variable by region). Previous Medicare/Medicaid Experience a plus .Call center or triage experience .Previous experience in utilization management, discharge planning and/or home health or rehab.

Required Schooling / Training

BSN or Bachelor degree in a related field

Who is the client company

Concern about healthcare service
If you are interested in this position, send your resume to