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RN Care Specialist (S)

Honolulu, HI 96813

Posted: 07/01/2019 Employment Type: Direct Hire Job Category: Admin/Clerical, Medical Job Number: 17337

Bishop & Company is seeking candidates for a RN Care Specialist  opportunity with an health insurance organization in Downtown Honolulu, HI.

RN Care Specialist#17337

Position Summary:

The RN Care Specialist I bridge the gap between administrative needs, data driven imperatives and the clinically relevant needs of our members. Nurses must emphasize these issues (access, quality, safety, statutory medical necessity, and attention to chronic disease) with alacrity and special attention to vulnerable populations while using clinical knowledge and judgment to align resources with member needs. This position effectively coordinates patient care/unit activities among the department, nursing peers, and physicians.

 

Essential Duties & Responsibilities:
  • Performs utilization management and care management under the direct supervision of the department clinical leadership
  • Performs utilization management and care coordination for less complex cases, while acquiring the necessary competencies for handling complex cases
  • Performs needs assessments, discharge planning and follow-up care coordination for members being discharged from inpatient care 
  • Confers with medical directors as necessary for any quality or safety issues identified  through the course of the reviews to discuss actions necessary to further patient safety and  all elements of the triple aim

 

Education and Experience:
  • Nursing Diploma or Associate degree in nursing from an accredited nursing program. Bachelor’ s Degree in Nursing or related field from an accredited  college or university preferred. New graduates are encouraged to apply!
  • Unrestricted, valid, and active RN License for the State of Hawaii.
  • Practice strong assessment and critical thinking skills and able to multi-task with demands of nursing industry.
  • Possess excellent interpersonal skills and are able to work cohesively with the entire  Nursing / Administrative team.
  • Valid driver’ s license and proof of automobile insurance.

 

Preferred and Advanced Qualifications:
  • Prior work experience in a similar role in care and/or utilization management preferred
  • Familiar with ICD-9/10 and CPT coding desirable
  • Knowledge of QNXT system desirable
  • Certification in Utilization Review or Care Management desirable
  • Other related specialized certification, desirable
  • Familiar with health insurance benefit management, community resources, and evidence-based medical guidelines

 

Physical Demands/Working Conditions:
  • Able to drive an automobile as needed to travel to hospitals on Oahu and, if necessary by airplane to the outer islands
  • Requires frequent standing, walking, sitting, stooping, walking, seeing, hearing and speaking
  • Daily use of a computer keyboard, mouse and viewing of a computer monitor
  • Requires on-site visits at facilities, provider offices, or other settings

 

Additional Information:

 
  • Typically Monday – Friday business hours. Extended and weekend hours may be required, depending upon the workload
  • Direct hire opportunity
  • Downtown Honolulu, HI

 


 

Bishop & Company provides recruiting and placement services for client companies and opportunities for job seekers throughout Hawaii, with emphasis on executive search, direct hire, temp to hire, and temporary/contract staffing. We charge no fees to our placed candidates and our temporary/contract employees. Our client services are 100% guaranteed.

 

Please forward resumes to:
Bishop & Company
Phone: 808-839-2200
Fax: 808-839-4844
Website: http://www.bishopco.net/

 

***No relocation, In-state applicants only. Must be available to interview immediately. ***

Location: Honolulu, HI

Equal Opportunity Employer – Disability and Veteran

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