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Medical Management (UM & CM)

$ by BFrench Consulting GmbH in Sinsheim, 5 days ago
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BFrench Consulting, GmbH is a Germany-based Service-Disabled Veteran-Owned Small Business (SDVOSB), providing Professional Management and Health Care Consulting Solutions to Government Service Organizations.

JOB OPENING
Full Time Employees (40 Hrs / Week)
Ramstein Air Base, Germany
Starting date: May 2018


POSITION
Medical Management:
Utilization Management (UM)
& Case Management (CM



JOB DESCRIPTION:

The contract registered nurses shall establish and implement a local, on-site UM and CM program.

? Develop and maintain a comprehensive MM program for Military Health System (MHS) beneficiaries
? Serve as a liaison with higher headquarters, TRICARE Regional Offices (TROs), Accreditation Association for Ambulatory Health Care (AAAHC), professional organizations, and community health care facilities
? Conduct first level reviews for referrals
? Plan and prioritize MM activities to ensure identified patient needs are addressed promptly. Act as facilitator of professional and patient care activities
? Examine, assess, monitor, and evaluate patient care MHS with regard to medical necessity and the efficient and effective allocation of medical and non-medical resources
? Maintain open and professional communication and working relationships, demonstrating excellent customer service skills
? Attend and participate in meetings, professional staff conferences
? Develop program literature, presentations, and marketing materials as needed
? Responsible for creating, maintaining, and disposing of Government records
? .Provide excellent patient assessment skills


QUALIFICATIONS:
? Registered Nurses (RN), Baccalaureate of Science of Nursing (BSN) preferred, must have proof of graduation from an accredited educational institution. A Master‘s Degree is highly recommended
? Possess a valid unrestricted license to practice as a Registered Nurse in the United States. The professional license must allow the holder to legally and independently practice without the supervision of another licensed professional
? Current certification in cardiopulmonary resuscitation (CPR) Basic Life Support (BLS) is required
? Familiarity with quality improvement process is required.
? Comprehension of essential information systems such as the Composite Health Care System (CHCS) and familiarity with Microsoft Word, Excel, PowerPoint, and Access is highly desirable
? Work experience with the military health care system including TRICARE health benefits or work experience involving the principles of fee-for-services

? For Utilization Management:
o Six (6) years of broad based clinical nursing experience and previous experience in UM is preferred
o Must possess the necessary knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines
o Must possess experience in performing prospective, concurrent, and retrospective reviews to justify medical necessity for medical care
o Working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9 (ICD-9), and Current Procedural Terminology-Version 4 (CPT-4) coding
o Minimum of two (2) years of recent experience (within the last four (4) years) in nursing

? For Case Management:
o Minimum of two (2) years recent experience (within the last four (4) years) in professional nursing or CM for adults, children, families, seniors, or groups
o Competency in performance of core activities of Case Management, i.e., patient advocacy, assessment, planning, implementation, coordination, monitoring, and evaluation
o Demonstrate expertise in resolving complicated healthcare, social, interpersonal, and financial patient situations
o Experience in program planning, implementation, and evaluation, and in conducting individual, family, group, and community assessments
o Demonstrate ability to communicate effectively both orally and in writing
o Knowledge of accreditation standards and privacy and confidentiality requirements, such as, AAAHC and HIPAA
o Knowledge of DoD, Federal, State, non-profit healthcare systems and organizations, to include DoD Tri-Service Military Healthcare Systems, TRICARE purchased care system, Medicare, Medicaid, Veterans Administration, Public Health Department, Regional and local support services



APPLICATION PROCESS:
Any interested persons in this position should submit resume, cover letter, and any applicable proof of certification highlighting the above qualifications to Ms. Anna Hug, Business Manager via E-Mail to anna.hug@consult-bfrench.com

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