Quality of Care Coordinator RN Exception Template

Summary:

• Work Mode: 100% Remote, National (Must work in EST schedule)
• Duration: 4 months contract
• Shift: Mon-Fri 8-5pm EST or 8:30-5:30pm EST, No OT

Responsibilities:

• Checking email box daily for Critical Incident referrals
• Entering referrals into the Delaware state tool
• Creating and completing assessments of the assigned member
• Communicating with the care coordination team regarding the status of the assigned member
• Updating tracker of assigned members
• Coordinating complex appeals cases
• Conducting clinical reviews
• Supporting medical necessity determinations
• Collaborating with medical doctors
• Ensuring compliance with state, federal, and contractual requirements
• Tracking and documenting statuses

Requirements:

• Education/Certification: Required: Associate’s degree in Nursing; Preferred: Bachelor’s degree in Nursing
• Licensure: Required: RN any state; Preferred: Compact
• Minimum 3 years of experience in nursing or related healthcare experience
• Disqualifiers: Big gaps in work experience, unstable work history, terminated due to poor performance

Preferred Skills:

• Willingness to learn
• Team player with good communication skills
• Ability to work MS Word and Excel efficiently