BAYADA Home Health Care is seeking a nurse (LPN or RN) to join our Managed Care Pediatrics team as a Clinical Associate in our Parsippany, NJ office.
This Clinical Associate opportunity is the perfect role for the nurse who wishes to utilize both their clinical knowledge and insurance/authorization experience to ensure that our pediatric clients are able to receive the care they need, in the comfort of their own homes.
The nurse in this role will act as a liaison between our internal service offices and the managed care payers, making sure that all services are authorized as needed.
Hours: M-F 8:30am - 5:00pm
Document all referrals, re-authorizations, and extensions of care clearly and accurately using appropriate computer system.
Communicate effectively with personnel in all service offices, including Client Services Manager, Clinical Managers, Directors, etc.
Prepare thorough reports and updates on patients’ conditions, when necessary, always using appropriate language and terminology with appropriate recommendations to ensure authorization of care.
Establish an organizational plan to manage caseload.
Function as a facilitator between Case Managers, other healthcare professionals, Client Services Managers, Clinical Managers and field staff.
Demonstrate sound clinical judgment; asks for assistance from Senior Clinical Associate, Clinical Manager and/or Senior Clinical Manager as needed.
Notify internal service offices as to when patient updates are required.
Willingly volunteers to take referrals.
Obtain physicians orders, when asked to do so by a service office.
Possess working understanding of the Managed Care system.
Cultivate positive and long-term relationships with referral sources.
Request and/or submit appropriate clinical documentation for authorization/reauthorization.
In addition to utilizing clinical judgement, the ideal nurse will possess the ability to build strong professional relationships with both internally and externally, and function as a Subject Matter Expert.